MEDICARE: JOLLYWOOD LIVE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3104A0630X	Assisted Living Facility (Behavioral Disturbances)
2	177F00000X	Lodging Provider
3	385H00000X	Respite Care
4	251B00000X	Case Management Agency
5	3104A0625X	Assisted Living Facility (Mental Illness)
6	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1326975921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOLLYWOOD LIVE

Provider Business Mailing Address
First Line	:	1121 W EDGEWARE RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-5168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 W EDGEWARE RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-5168
Country	:	US
Telephone Number	:	323-492-8053
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ELISSA CHOW
Credential	:
Telephone Number	:	323-492-8053

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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Directions to “JOLLYWOOD LIVE ” Practice Location

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