Provider Demographics
NPI:1043410863
Name:LEISURE VALE RETIREMENT HOTEL
Entity Type:Organization
Organization Name:LEISURE VALE RETIREMENT HOTEL
Other - Org Name:B. V. GENERAL, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:POLITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-244-2323
Mailing Address - Street 1:413 E CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3334
Mailing Address - Country:US
Mailing Address - Phone:818-244-2323
Mailing Address - Fax:818-244-3147
Practice Address - Street 1:413 E CYPRESS ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3334
Practice Address - Country:US
Practice Address - Phone:818-244-2323
Practice Address - Fax:818-244-3147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARCF00017FOtherMEDI-CAL