=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346526142
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOPANGA ROSCOE CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2011
-----------------------------------------------------
Last Update Date | 10/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22115 ROSCOE BLVD
-----------------------------------------------------
City | CANOGA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91304-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-905-8000
-----------------------------------------------------
Fax | 818-905-8002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15760 VENTURA BLVD SUITE 920
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-3000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-905-8000
-----------------------------------------------------
Fax | 818-905-8002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. CARY BUCHMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-905-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------