Provider Demographics
NPI:1457170839
Name:AGAPE ELDERLY ASSISTED LIVING CORP
Entity type:Organization
Organization Name:AGAPE ELDERLY ASSISTED LIVING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ESTELA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVETYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-436-9088
Mailing Address - Street 1:1431 THURLENE RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1346
Mailing Address - Country:US
Mailing Address - Phone:818-436-9088
Mailing Address - Fax:
Practice Address - Street 1:10940 STRATHERN ST
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-4649
Practice Address - Country:US
Practice Address - Phone:818-436-9088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances