Provider Demographics
NPI:1407685183
Name:GRANT SERENITY ON CHARLOTTE, INC.
Entity type:Organization
Organization Name:GRANT SERENITY ON CHARLOTTE, 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:CEO
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:
Practice Address - Street 1:5588 N CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1621
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:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility