MEDICARE: MISHKAN SENIOR CARE CORP.

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	197608546	CA

General Provider Information

NPI Number	:	1205298353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISHKAN SENIOR CARE CORP.

Provider Business Mailing Address
First Line	:	6230 WILSHIRE BLVD STE 2070
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5138
Country	:	US
Telephone Number	:	818-378-7422
Fax Number	:

Provider Business Practice Location Address
First Line	:	6230 WILSHIRE BLVD STE 2070
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5138
Country	:	US
Telephone Number	:	818-378-7422
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. JUSTIN MICHAEL LEVI
Credential	:
Telephone Number	:	818-378-7422

Provider Enumeration Date	:	03/27/2016
Last Update Date	:	03/27/2016

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