Provider Demographics
NPI:1932958170
Name:ENCINO TERRACE, LLC
Entity type:Organization
Organization Name:ENCINO TERRACE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAFISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-497-6497
Mailing Address - Street 1:4921 BELLAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3418
Mailing Address - Country:US
Mailing Address - Phone:310-497-6497
Mailing Address - Fax:
Practice Address - Street 1:16025 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4451
Practice Address - Country:US
Practice Address - Phone:310-497-6497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-17
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility