Provider Demographics
NPI:1588492177
Name:ASSISTED LIVING ON GLADE LLC
Entity type:Organization
Organization Name:ASSISTED LIVING ON GLADE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOVSESYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-696-3110
Mailing Address - Street 1:10140 GLADE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2856
Mailing Address - Country:US
Mailing Address - Phone:747-202-0025
Mailing Address - Fax:
Practice Address - Street 1:10140 GLADE AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2856
Practice Address - Country:US
Practice Address - Phone:747-202-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility