MEDICARE: ADAT SHALOM MANOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	197602923	CA

General Provider Information

NPI Number	:	1023349271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAT SHALOM MANOR

Provider Business Mailing Address
First Line	:	6624 SALE AVE
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-3628
Country	:	US
Telephone Number	:	818-704-9090
Fax Number	:	818-704-9696

Provider Business Practice Location Address
First Line	:	6624 SALE AVE
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-3628
Country	:	US
Telephone Number	:	818-704-9090
Fax Number	:	818-704-9696

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MRS. ANGELICA REINGOLD
Credential	:
Telephone Number	:	818-704-9090

Provider Enumeration Date	:	01/27/2010
Last Update Date	:	01/27/2010

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