MEDICARE: ALDEA BY THE LAKE SENIOR LIVING LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1528920139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALDEA BY THE LAKE SENIOR LIVING LLC

Provider Business Mailing Address
First Line	:	6406 ALDEA AVE
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-5401
Country	:	US
Telephone Number	:	954-552-7038
Fax Number	:

Provider Business Practice Location Address
First Line	:	6406 ALDEA AVE
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-5401
Country	:	US
Telephone Number	:	954-552-7038
Fax Number	:

Authorized Official
Title or Position	:	LICENSEE
Name	:	TALHA SYED
Credential	:
Telephone Number	:	954-552-7038

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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