Provider Demographics
NPI:1225818651
Name:SOUTH VALLEY SENIOR CARE LLC
Entity Type:Organization
Organization Name:SOUTH VALLEY SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SLADE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABISROR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-640-2223
Mailing Address - Street 1:4949 GENESTA AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3442
Mailing Address - Country:US
Mailing Address - Phone:323-640-2223
Mailing Address - Fax:
Practice Address - Street 1:16250 VENTURA BLVD STE 115
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2268
Practice Address - Country:US
Practice Address - Phone:323-640-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care