MEDICARE: SAFEWAY SENIOR LIVING 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	:	1679314868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFEWAY SENIOR LIVING INC

Provider Business Mailing Address
First Line	:	15725 LEMARSH ST
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-1511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15725 LEMARSH ST
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-1511
Country	:	US
Telephone Number	:	818-344-5555
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANNA SARGSYAN
Credential	:
Telephone Number	:	818-344-5555

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	06/03/2024

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