Provider Demographics
NPI:1215191358
Name:NORTH LAKE VILLAS INC.
Entity Type:Organization
Organization Name:NORTH LAKE VILLAS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOURIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-398-8668
Mailing Address - Street 1:2851 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-1619
Mailing Address - Country:US
Mailing Address - Phone:626-398-8668
Mailing Address - Fax:626-398-7140
Practice Address - Street 1:2851 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-1619
Practice Address - Country:US
Practice Address - Phone:626-398-8668
Practice Address - Fax:626-398-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197603823310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility