Organization
LEISURE VILLAGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOKE AHANKOOB (PRESIDENT)
(818) 585-2200
Entity
Organization
Contact information
Practice address
6728 GAVIOTA AVE, LAKE BALBOA, CA 91406-5944
(818) 585-2200
(818) 387-6445
Mailing address
6728 GAVIOTA AVE, LAKE BALBOA, CA 91406-5944
(818) 585-2200
(818) 387-6445
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
197607543
CA
Other
Enumeration date
09/22/2016
Last updated
09/22/2016
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