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
6726 1/2 GAVIOTA AVE., LAKE BALBOA, CA 91406
(818) 585-2200
Mailing address
19562 VENTURA BLVD, SUITE 229, TARZANA, CA 91356-2955
(818) 585-2200
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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