Organization
PRIME RESIDENTIAL SENIOR CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOFYA N/A KHECHIKYAN (ADMINISTRATOR)
(818) 858-3553
Entity
Organization
Contact information
Practice address
19418 LANARK ST, RESEDA, CA 91335-1013
(818) 626-8553
Mailing address
19418 LANARK ST, RESEDA, CA 91335-1013
(818) 626-8553
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
Other
Enumeration date
07/03/2023
Last updated
07/03/2023
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