Organization
LEISURE VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOKE AHANKOOB (PRESIDENT)
(818) 402-7867
Entity
Organization
Contact information
Practice address
19562 VENTURA BLVD STE 229, TARZANA, CA 91356-7126
(818) 585-2200
Mailing address
19562 VENTURA BLVD STE 229, TARZANA, CA 91356-7126
(818) 585-2200
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
197607542
CA
Other
Enumeration date
08/05/2016
Last updated
08/05/2016
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