MEDICARE: LILOS TENDER SENIOR CARE 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1548016561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILOS TENDER SENIOR CARE INC

Provider Business Mailing Address
First Line	:	13153 CONSTABLE AVE
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-1106
Country	:	US
Telephone Number	:	818-284-2502
Fax Number	:

Provider Business Practice Location Address
First Line	:	4149 ROLANDO BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-6813
Country	:	US
Telephone Number	:	818-284-2502
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANNA PETROSYAN
Credential	:
Telephone Number	:	818-284-2502

Provider Enumeration Date	:	04/29/2024
Last Update Date	:	04/15/2025

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Directions to “LILOS TENDER SENIOR CARE INC ” Practice Location

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