Organization
TITAN WILLOW OPERATOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN KASEFF (MANAGER)
(310) 725-0120
Entity
Organization
Contact information
Practice address
898 S MERIDIAN ST, BLACKFOOT, ID 83221-2660
(208) 782-1478
Mailing address
2301 ROSECRANS AVE STE 4170, EL SEGUNDO, CA 90245-4966
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
04/14/2023
Last updated
05/22/2023
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