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General NPI Number Information
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NPI Number | 1043026636
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Entity Type | Organization
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Legal Business Name | FAIRWAY ASSISTED LIVING INC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 2623 FAIRWAY AVE
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City | MONTROSE
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State | CA
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Zip | 91020-1409
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Country | US
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Telephone | 818-653-2439
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Fax |
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Provider Business Mailing Address
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Address Line | 2623 FAIRWAY AVE
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City | MONTROSE
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State | CA
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Zip | 91020-1409
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Country | US
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Telephone | 818-653-2439
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Fax |
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Authorized Official
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Title or Position | ADMIN/CEO
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Name | SEDA MURADYAN
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Credential | ADMINISTRATOR
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Telephone | 818-653-2439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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