Organization
LEISURE VILLAGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KOKE AHANKOOB (PRESIDENT)
(818) 402-7867
Entity
Organization
Contact information
Practice address
6726 GAVIOTA AVE, LAKE BALBOA, CA 91406-5944
(818) 402-7867
(818) 774-0563
Mailing address
19528 VENTURA BLVD STE 660, TARZANA, CA 91356-2917
(818) 386-8599
(818) 774-0563
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
CA
Other
Enumeration date
03/20/2008
Last updated
03/20/2008
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