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General NPI Number Information
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NPI Number | 1568121549
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Entity Type | Organization
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Legal Business Name | LAKE ENCINO, INC.
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Dates
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Enumeration Date | 12/17/2021
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 2215 W 15TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90006-4703
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Country | US
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Telephone | 323-656-8266
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Fax | 866-910-2595
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Provider Business Mailing Address
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Address Line | 340 S LEMON AVE # 9888
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City | WALNUT
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State | CA
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Zip | 91789-2706
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Country | US
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Telephone | 323-656-8266
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Fax | 866-910-2595
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Authorized Official
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Title or Position | CEO
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Name | HAKOP LALOYAN
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Credential |
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Telephone | 323-656-8266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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