Provider Demographics
NPI:1801518956
Name:LA WELLNESS HOME INC.
Entity type:Organization
Organization Name:LA WELLNESS HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ISHKHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHAZIZYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-808-0108
Mailing Address - Street 1:2428 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-2627
Mailing Address - Country:US
Mailing Address - Phone:818-808-0108
Mailing Address - Fax:323-892-3866
Practice Address - Street 1:2428 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-2627
Practice Address - Country:US
Practice Address - Phone:818-808-0108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility