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General NPI Number Information
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NPI Number | 1790412351
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Entity Type | Organization
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Legal Business Name | VIP SENIOR LIVING LLC
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 5457 WOODMAN AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91401-5832
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Country | US
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Telephone | 818-994-4116
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Fax |
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Provider Business Mailing Address
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Address Line | 1547 E DOUBLEGROVE ST
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City | WEST COVINA
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State | CA
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Zip | 91791-4035
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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 | LICENSEE
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Name | JEFFREY ALVAREZ
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Credential |
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Telephone | 626-373-4386
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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 |
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License Number State |
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