MEDICARE: EISENBERG VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING

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	313M00000X	Nursing Facility/Intermediate Care Facility	920000043	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215930995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EISENBERG VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING

Provider Business Mailing Address
First Line	:	18855 VICTORY BLVD
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-6445
Country	:	US
Telephone Number	:	818-774-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	18855 VICTORY BLVD
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-6445
Country	:	US
Telephone Number	:	818-774-3000
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. MARY M FORREST
Credential	:
Telephone Number	:	818-774-9208

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/20/2011

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Directions to “EISENBERG VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING ” Practice Location

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