Healthcare Provider Details

I. General information

NPI: 1184149692
Provider Name (Legal Business Name): ROSE GARDEN CONGREGATE LIVING HEALTH FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 VIVIAN CIR
THOUSAND OAKS CA
91320-2740
US

IV. Provider business mailing address

18210 KAREN DR
TARZANA CA
91356-4608
US

V. Phone/Fax

Practice location:
  • Phone: 818-599-5076
  • Fax:
Mailing address:
  • Phone:
  • 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: LARYSA LIAKHOVETSKI
Title or Position: CEO / OWNER
Credential:
Phone: 818-599-5076