Provider Demographics
NPI:1720857766
Name:QUEEN OF ANGELS RESIDENTIAL CARE FACILITY
Entity Type:Organization
Organization Name:QUEEN OF ANGELS RESIDENTIAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SONA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYRAPETYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-684-1609
Mailing Address - Street 1:6621 TEESDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1209
Mailing Address - Country:US
Mailing Address - Phone:323-684-1609
Mailing Address - Fax:
Practice Address - Street 1:9514 RUBIO AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91343-2614
Practice Address - Country:US
Practice Address - Phone:323-684-1609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness