Provider Demographics
NPI:1285162834
Name:AV HOLDING, INC.
Entity type:Organization
Organization Name:AV HOLDING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-435-0696
Mailing Address - Street 1:3711 WESLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-4732
Mailing Address - Country:US
Mailing Address - Phone:310-435-0696
Mailing Address - Fax:323-939-0183
Practice Address - Street 1:4836 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-1519
Practice Address - Country:US
Practice Address - Phone:323-937-4506
Practice Address - Fax:323-939-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198600525311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home