MEDICARE: MELROSE GARDENS

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	:	1750010195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELROSE GARDENS

Provider Business Mailing Address
First Line	:	960 N MARTEL AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-6608
Country	:	US
Telephone Number	:	323-251-1426
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 N MARTEL AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-6608
Country	:	US
Telephone Number	:	323-251-1426
Fax Number	:

Authorized Official
Title or Position	:	LICENSEE
Name	:	BARUCH BERKOWITZ
Credential	:
Telephone Number	:	323-251-1426

Provider Enumeration Date	:	06/09/2022
Last Update Date	:	06/09/2022

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Directions to “MELROSE GARDENS ” Practice Location

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