MEDICARE: CARMEL OAKS ASSISTED LIVING

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	:	1639791288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARMEL OAKS ASSISTED LIVING

Provider Business Mailing Address
First Line	:	4607 LENNOX AVE
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-2692
Country	:	US
Telephone Number	:	818-913-7799
Fax Number	:

Provider Business Practice Location Address
First Line	:	4607 LENNOX AVE
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-2692
Country	:	US
Telephone Number	:	760-400-0947
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NIRVANA GHAEMI MAHMOODZADEH
Credential	:
Telephone Number	:	818-913-7799

Provider Enumeration Date	:	05/16/2020
Last Update Date	:	05/16/2020

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