Provider Demographics
NPI:1427754274
Name:ASSURED LIFESTYLE HOUSING
Entity type:Organization
Organization Name:ASSURED LIFESTYLE HOUSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LANEAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-974-3253
Mailing Address - Street 1:9350 WILSHIRE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3204
Mailing Address - Country:US
Mailing Address - Phone:310-974-3253
Mailing Address - Fax:310-974-3254
Practice Address - Street 1:219 W 98TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-4110
Practice Address - Country:US
Practice Address - Phone:310-974-3253
Practice Address - Fax:310-974-3254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health