Healthcare Provider Details

I. General information

NPI: 1588587877
Provider Name (Legal Business Name): OMNICARE RESIDENTIAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 THAMES ST
THOUSAND OAKS CA
91360-3440
US

IV. Provider business mailing address

154 THAMES ST
THOUSAND OAKS CA
91360-3440
US

V. Phone/Fax

Practice location:
  • Phone: 805-777-8143
  • Fax:
Mailing address:
  • Phone: 805-777-8143
  • 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: LAILA KULUNGU
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-235-9486