Provider Demographics
NPI:1023588936
Name:WELLNESS CONGREGATED LIVING FACILITY
Entity type:Organization
Organization Name:WELLNESS CONGREGATED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/COO
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AVETISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-888-0909
Mailing Address - Street 1:6231 ETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-3220
Mailing Address - Country:US
Mailing Address - Phone:818-782-7276
Mailing Address - Fax:818-935-6245
Practice Address - Street 1:6231 ETHEL AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-3220
Practice Address - Country:US
Practice Address - Phone:818-782-7276
Practice Address - Fax:818-935-6245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care