LEISURE VILLAGE (NPI# 1003360124) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003360124 |
| Entity Type | Organization |
| Organization Name | LEISURE VILLAGE |
| Practice Address |
19562 Ventura Blvd Ste 229 Tarzana CA 91356-7126 |
| Practice Telephone | 8185852200 |
| Mailing Telephone | 8185852200 |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2016-08-05 |
| Authorized Official Name | KOKE AHANKOOB (PRESIDENT) |
| Authorized Official Telephone | 8184027867 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 197607542 | CA | Nursing & Custodial Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | LEISURE VILLAGE | 406 N B St, Edgar, NE 68935-3206 |
| Oregon Corporations, Companies and Business Names | LEISURE VILLAGE | 625 E Valley View, Ashland, OR 97520 |
| System for Award Management (SAM) Entities | LEISURE VILLAGE APARTMENTS | 210 W Mallard Dr, Boise, ID 83706-6642 |
| New York State Corporations | LEISURE VILLAGE APARTMENTS, LLC | 2040 Military Road, Tonawanda, Ny 14150 |
| System for Award Management (SAM) Entities | LEISURE VILLAGE HEALTH CARE CENTER | 2154 S 85th E Ave, Tulsa, OK 74129-3012 |
| Oklahoma Business Registrations | LEISURE VILLAGE HEALTH CARE, LLC | 2 City Place Drive, Suite 200, St. Louis, MO 63017 |
| New York State Corporations | LEISURE VILLAGE II, LLC | 169 Route 303, Valley Cottage, Ny 10989 |
| New York State Corporations | LEISURE VILLAGE MHP, LLC | P.o. Box 669, Red Hook, Ny 12571 |
| New York State Corporations | LEISURE VILLAGE, INC. | 4225 State Route 69, Taberg, New York 13471 |
| Massachusetts Corporations | LEISURE VILLAGE-MASSACHUSETTS, INC. | 1 Airport Rd, Lakewood Nj, NJ 08701 |
| Street Address |
19562 VENTURA BLVD STE 229 |
| City | TARZANA |
| State | CA |
| Zip Code | 91356-7126 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689049678 | Arclight Hospice, Inc. | Hospice Care, Community Based | 19562 Ventura Blvd Ste 229, Tarzana, CA 91356-7126 | 2015-12-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679137293 | Sarah Badreau | Behavior Technician | 5554 Reseda Blv., Tarzana, CA 91356 | 2019-04-29 |
| 1831661966 | Daraie Dental Group Inc | Dentist | 5620 Wilbur Avenue Ste 300, Tarzana, CA 91356 | 2018-12-31 |
| 1982182770 | Blanca Garay | Respiratory Therapist, Registered | 18214 Burbank Blvd Apt 120, Tarzana, CA 91356 | 2018-08-02 |
| 1437659000 | Chloe Kang | Speech-Language Pathologist | 19019 Ventura Blvd., Tarzana, CA 91356 | 2018-02-20 |
| 1114430139 | Avb & Lv Corporation | Home Health | 18340 Ventura Blvd Ste 220, Tarzana, CA 91356 | 2017-11-13 |
| 1881110468 | Samina Qadir | Registered Nurse | 18321 Clark St., Tarzana, CA 91356 | 2017-08-16 |
| 1700306776 | Debbie Rehman Lux | Marriage & Family Therapist | 18370 Burbank Blvd., Suite 211, Tarzana, CA 91356 | 2017-06-21 |
| 1467980631 | Valley Nerological Services, LLC | Radiology | 5260 Wilbur Ave Ste 207, Tarzana, CA 91356 | 2017-05-31 |
| 1669906020 | Evolve Growth Initiatives LLC | Clinic/Center | 5435 Aura Avenue, Tarzana, CA 91356 | 2017-04-12 |
| 1780130088 | Evolve Growth Initiatives, LLC | Clinic/Center | 5358 Vanalden Drive, Tarzana, CA 91356 | 2016-08-28 |
| Find all providers in zip 91356 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174185193 | Synergy Flow Inc. | Assisted Living Facility | 18242 Sylvan St, Tarzana, CA 91335-7047 | 2019-06-29 |
| 1760915391 | Imperiumseniorlivingllc | Assisted Living Facility | 5236 Otis Ave, Tarzana, CA 91356-4212 | 2017-04-11 |
| 1275075426 | Tarzana Manor | Assisted Living Facility | 18162 Rancho St, Tarzana, CA 91356-4616 | 2016-11-04 |
| 1952631848 | Summerville At Cobbco, Inc. | Assisted Living Facility | 5711 Reseda Blvd, Tarzana, CA 91356-2201 | 2009-12-28 |
| 1720685720 | Tarzana Senior Living, Inc. | Assisted Living Facility | 5236 Otis Ave, Tarzana, CA 91356-4212 | 2020-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710588165 | Nana's Garden II | Assisted Living Facility | 25312 Ericson Way, Laguna Hills, CA 92653-5054 | 2020-11-03 |
| 1609476589 | Southbay Care Home, Inc. | Assisted Living Facility | 19917 Anza Avenue, Torrance, CA 90503-2005 | 2020-10-29 |
| 1821697434 | Global Regency Senior Care Services, LLC | Assisted Living Facility | 117 E 8th St, Long Beach, CA 90813-4397 | 2020-10-23 |
| 1689273419 | Pacifica Slo LLC | Assisted Living Facility | 475 Marsh St, San Luis Obispo, CA 93401-6108 | 2020-10-22 |
| 1871192682 | Pacifica Sfo LLC | Assisted Living Facility | 624 Laguna St, San Francisco, CA 94102-4217 | 2020-10-22 |
| 1528667367 | Pacifica Sierra Vista Lp | Assisted Living Facility | 13815 Rodeo Dr, Victorville, CA 92395-5600 | 2020-10-22 |
| 1992304737 | West Lyons Lp | Assisted Living Facility | 24305 Lyons Ave, Newhall, CA 91321-2344 | 2020-10-22 |
| 1619576451 | Pacifica Orange County LLC | Assisted Living Facility | 2619 Orange Ave, Costa Mesa, CA 92627-4630 | 2020-10-22 |
| 1720687551 | P San Leandro Lp | Assisted Living Facility | 348 W Juana Ave, San Leandro, CA 94577-3661 | 2020-10-22 |
| 1952900730 | Pacifica Daly LLC | Assisted Living Facility | 995 E Market St, Daly City, CA 94014-2168 | 2020-10-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.