Healthcare Provider Details

I. General information

NPI: 1962313726
Provider Name (Legal Business Name): AMANAH SENIOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E CALAVERAS ST
ALTADENA CA
91001-2218
US

IV. Provider business mailing address

400 E CALAVERAS ST
ALTADENA CA
91001-2218
US

V. Phone/Fax

Practice location:
  • Phone: 626-499-4212
  • Fax: 626-210-2574
Mailing address:
  • Phone: 626-499-4212
  • Fax: 626-210-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: IMRAN SYED
Title or Position: DIRECTOR
Credential:
Phone: 626-499-4212