MEDICARE: SENIOR LIVING NORWOODS HACIENDA

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

General Provider Information

NPI Number	:	1457132128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR LIVING NORWOODS HACIENDA

Provider Business Mailing Address
First Line	:	17404 MARTHA ST
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-1323
Country	:	US
Telephone Number	:	818-858-7543
Fax Number	:

Provider Business Practice Location Address
First Line	:	4149 ROLANDO BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-6813
Country	:	US
Telephone Number	:	818-858-7543
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LINET MANASYAN
Credential	:
Telephone Number	:	818-858-7543

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	10/09/2023

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Directions to “SENIOR LIVING NORWOODS HACIENDA ” Practice Location

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