Provider Demographics
NPI:1114306685
Name:PLAZA RESIDENTIAL ENTERPRISES INC.
Entity Type:Organization
Organization Name:PLAZA RESIDENTIAL ENTERPRISES INC.
Other - Org Name:COURTYAD PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-780-5005
Mailing Address - Street 1:6951 LENNOX AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4034
Mailing Address - Country:US
Mailing Address - Phone:818-780-5005
Mailing Address - Fax:818-780-5176
Practice Address - Street 1:6951 LENNOX AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4034
Practice Address - Country:US
Practice Address - Phone:818-780-5005
Practice Address - Fax:818-780-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197603560310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility