MEDICARE: FRIENDSHIP CIRCLE OF THE WEST COAST

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1851276455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDSHIP CIRCLE OF THE WEST COAST

Provider Business Mailing Address
First Line	:	17315 W SUNSET BLVD
Second Line	:
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-4101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17315 W SUNSET BLVD
Second Line	:
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-4101
Country	:	US
Telephone Number	:	917-455-9179
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SHIMON GOLDBERG
Credential	:
Telephone Number	:	917-455-9179

Provider Enumeration Date	:	08/11/2025
Last Update Date	:	08/11/2025

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