Queen Comfort Care Center

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

197608550 Issued in CA

Legal business name

QUEEN COMFORT CARE CENTER

Practice address

6534 McLennan Ave
Lake Balboa, CA 91406-5543

Phone

(818) 616-1761

NPI assigned

Jul 12, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Nino Gelashvill

Title

Owner

Phone

(818) 370-2339

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436659200000",
    "number": "1598149387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6534 MCLENNAN AVE",
            "city": "LAKE BALBOA",
            "state": "CA",
            "postal_code": "914065543",
            "telephone_number": "818-616-1761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6534 MCLENNAN AVE",
            "city": "LAKE BALBOA",
            "state": "CA",
            "postal_code": "914065543",
            "telephone_number": "818-616-1761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEEN COMFORT CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-12",
        "last_updated": "2015-07-12",
        "status": "A",
        "authorized_official_last_name": "GELASHVILL",
        "authorized_official_first_name": "NINO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-370-2339",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "CA",
            "license": "197608550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197608550",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Health Maintenance Organization in Lake Balboa, CA
• Providers in Lake Balboa, CA by specialty
• Health Maintenance Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.