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General NPI Number Information
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NPI Number | 1326975921
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Entity Type | Organization
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Legal Business Name | JOLLYWOOD LIVE
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Dates
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Enumeration Date | 05/06/2026
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Last Update Date | 05/06/2026
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Provider Practice Location Address
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Address Line | 1121 W EDGEWARE RD
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City | LOS ANGELES
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State | CA
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Zip | 90026-5168
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Country | US
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Telephone | 323-492-8053
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 W EDGEWARE RD
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City | LOS ANGELES
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State | CA
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Zip | 90026-5168
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ELISSA CHOW
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Credential |
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Telephone | 323-492-8053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #6
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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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