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General NPI Number Information
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NPI Number | 1093998411
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Entity Type | Organization
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Legal Business Name | LAUREL CANYON RETIREMENT COMMUNITY, INC
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 5527 LAUREL CANYON BLVD
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-2116
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Country | US
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Telephone | 818-769-6626
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Fax | 818-753-5018
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Provider Business Mailing Address
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Address Line | 5527 LAUREL CANYON BLVD
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-2116
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Country | US
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Telephone | 818-769-6626
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Fax | 818-753-5018
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TILLMAN PINK JR.
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Credential |
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Telephone | 818-769-6629
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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 | CA
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