MEDICARE: E D GARDENS 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		CA

General Provider Information

NPI Number	:	1770761363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E D GARDENS INC.

Provider Business Mailing Address
First Line	:	3630 TERRACE VIEW DR
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-4020
Country	:	US
Telephone Number	:	818-784-8624
Fax Number	:	818-783-2840

Provider Business Practice Location Address
First Line	:	23601 CANZONET ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-5845
Country	:	US
Telephone Number	:	818-348-2308
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ROHANGIZ SOLAIMANI YADIDI
Credential	:
Telephone Number	:	818-784-8624

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	02/06/2008

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