Healthcare Provider Details

I. General information

NPI: 1477062412
Provider Name (Legal Business Name): FOR SENIOR CARE , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 YOSEMITE AVE
SIMI VALLEY CA
93063-3540
US

IV. Provider business mailing address

19808 AHWANEE LN
PORTER RANCH CA
91326-4121
US

V. Phone/Fax

Practice location:
  • Phone: 805-285-7858
  • Fax: 805-335-6878
Mailing address:
  • Phone: 818-581-8304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: RICHARD DOW PERRINE
Title or Position: OPERATIONS OFFICER
Credential:
Phone: 818-581-8304