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General NPI Number Information
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NPI Number | 1407230246
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Entity Type | Organization
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Legal Business Name | BORIS MANAGEMENT CORP
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 3454 PERLITA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90039-1932
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Country | US
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Telephone | 323-665-6893
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Fax | 323-658-5533
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Provider Business Mailing Address
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Address Line | 3454 PERLITA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90039-1932
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Country | US
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Telephone | 323-665-6893
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Fax | 323-658-5533
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BORIS SKUTATOVICH
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Credential |
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Telephone | 323-610-2841
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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 | 197608929
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License Number State | CA
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