=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639791288
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARMEL OAKS ASSISTED LIVING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2020
-----------------------------------------------------
Last Update Date | 05/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4607 LENNOX AVE
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91423-2692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-400-0947
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4607 LENNOX AVE
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91423-2692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-913-7799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | NIRVANA GHAEMI MAHMOODZADEH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-913-7799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------