MEDICARE: LE FOYER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1043446024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LE FOYER, INC.

Provider Business Mailing Address
First Line	:	10710 BELMAR AVE
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-2202
Country	:	US
Telephone Number	:	818-360-8046
Fax Number	:	818-360-0795

Provider Business Practice Location Address
First Line	:	16438 BLACKHAWK ST
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6731
Country	:	US
Telephone Number	:	818-360-8046
Fax Number	:	818-360-0795

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARIANO LACSAMANA
Credential	:
Telephone Number	:	818-360-8046

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	06/04/2009

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