Provider Demographics
NPI:1669767778
Name:PROTOCOL AGENCY, INC
Entity type:Organization
Organization Name:PROTOCOL AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKISYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-878-8595
Mailing Address - Street 1:875 S WESTLAKE BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2915
Mailing Address - Country:US
Mailing Address - Phone:818-878-8595
Mailing Address - Fax:
Practice Address - Street 1:875 S WESTLAKE BLVD STE 112
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2915
Practice Address - Country:US
Practice Address - Phone:818-878-8595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251J00000X
CA11369314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251B00000XAgenciesCase Management
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility