Healthcare Provider Details

I. General information

NPI: 1861308439
Provider Name (Legal Business Name): FAIRFAX PLAZA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N HAYWORTH AVE
LOS ANGELES CA
90048-2701
US

IV. Provider business mailing address

7162 BEVERLY BLVD STE 263
LOS ANGELES CA
90036-2547
US

V. Phone/Fax

Practice location:
  • Phone: 323-655-3101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: BARUCH BERKOWITZ
Title or Position: MANAGER
Credential:
Phone: 213-876-7424