Provider Demographics
NPI:1104589506
Name:GRANT SERENITY HOMES OF SF VALLEY, INC.
Entity type:Organization
Organization Name:GRANT SERENITY HOMES OF SF VALLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NVARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GEVORKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:818-425-6797
Mailing Address - Street 1:441 N REESE PL
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1956
Mailing Address - Country:US
Mailing Address - Phone:818-425-6797
Mailing Address - Fax:818-953-9091
Practice Address - Street 1:6928 PEACH AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-5230
Practice Address - Country:US
Practice Address - Phone:818-425-6797
Practice Address - Fax:818-953-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility