MEDICARE: LUDLOW ASSISTED LIVING FACILITY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	310400000X	Assisted Living Facility
2	3104A0630X	Assisted Living Facility (Behavioral Disturbances)
3	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1447045497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUDLOW ASSISTED LIVING FACILITY

Provider Business Mailing Address
First Line	:	17832 LUDLOW ST
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-4522
Country	:	US
Telephone Number	:	747-300-2444
Fax Number	:

Provider Business Practice Location Address
First Line	:	17832 LUDLOW ST
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-4522
Country	:	US
Telephone Number	:	747-300-2444
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TATEVIK BALASANYAN
Credential	:
Telephone Number	:	818-614-7923

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	04/15/2025

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