Healthcare Provider Details

I. General information

NPI: 1548190317
Provider Name (Legal Business Name): ISLAND GARDEN ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9765 SHADOW ISLAND DR
SHADOW HILLS CA
91040-1517
US

IV. Provider business mailing address

9765 SHADOW ISLAND DR
SHADOW HILLS CA
91040-1517
US

V. Phone/Fax

Practice location:
  • Phone: 818-590-4682
  • 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: ROMEO BALASANYAN
Title or Position: CEO
Credential:
Phone: 818-590-4682