Organization
LAKE BALBOA CONGREGATE LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GEVORGYAN (CEO)
(818) 773-0700
Entity
Organization
Contact information
Practice address
17527 COVELLO ST, LAKE BALBOA, CA 91406-2320
(818) 773-0700
Mailing address
17527 COVELLO ST, LAKE BALBOA, CA 91406-2320
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
05/29/2015
Last updated
05/29/2015
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