Organization
MIRACLE BOARD AND CARE&ASSSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUISA SARAFYAN (OWNER)
(818) 439-0611
Entity
Organization
Contact information
Practice address
17646 CALVERT ST, ENCINO, CA 91316-1216
(818) 344-1650
(818) 344-1753
Mailing address
17646 CALVERT ST, ENCINO, CA 91316-1216
(818) 344-1650
(818) 344-1753
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
197608216
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
197608216
LIC. RESIDENTIL CARE FACILITY
CA
Enumeration date
08/22/2013
Last updated
08/22/2013
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