Provider Demographics
NPI:1922534916
Name:WELL CARE CONGREGATE LIVING HEALTH FACILITY, INC
Entity Type:Organization
Organization Name:WELL CARE CONGREGATE LIVING HEALTH FACILITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OGANES
Authorized Official - Middle Name:
Authorized Official - Last Name:AZATYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-646-1138
Mailing Address - Street 1:14926 VOSE ST.
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405
Mailing Address - Country:US
Mailing Address - Phone:818-646-1138
Mailing Address - Fax:818-646-1139
Practice Address - Street 1:14926 VOSE ST.
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:818-646-1138
Practice Address - Fax:818-646-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility