Provider Demographics
NPI:1174601280
Name:VERDUGO VALLEY CONVALESCENT HOSPITAL
Entity type:Organization
Organization Name:VERDUGO VALLEY CONVALESCENT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATCHADURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-882-7740
Mailing Address - Street 1:9420 TOPANGA CANYON BLVD
Mailing Address - Street 2:#207
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5759
Mailing Address - Country:US
Mailing Address - Phone:818-882-7740
Mailing Address - Fax:818-882-7764
Practice Address - Street 1:9420 TOPANGA CANYON BLVD
Practice Address - Street 2:#207
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-5759
Practice Address - Country:US
Practice Address - Phone:818-882-7740
Practice Address - Fax:818-882-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05346HMedicaid
CAZZT05346HMedicaid