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General NPI Number Information
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NPI Number | 1275075426
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Entity Type | Organization
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Legal Business Name | TARZANA MANOR
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 18162 RANCHO ST
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City | TARZANA
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State | CA
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Zip | 91356-4616
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Country | US
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Telephone | 818-758-9323
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Fax |
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Provider Business Mailing Address
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Address Line | 18162 RANCHO ST
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City | TARZANA
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State | CA
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Zip | 91356-4616
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Country | US
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Telephone | 818-758-9323
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DINA PAMATMAT
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Credential |
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Telephone | 818-758-9232
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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 | 197604926
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License Number State | CA
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