Provider Demographics
NPI:1477062412
Name:FOR SENIOR CARE , LLC
Entity Type:Organization
Organization Name:FOR SENIOR CARE , LLC
Other - Org Name:CALIFORNIA CONGREGATE LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DOW
Authorized Official - Last Name:PERRINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-581-8304
Mailing Address - Street 1:19808 AHWANEE LN
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4121
Mailing Address - Country:US
Mailing Address - Phone:818-581-8304
Mailing Address - Fax:
Practice Address - Street 1:2333 YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3540
Practice Address - Country:US
Practice Address - Phone:805-285-7858
Practice Address - Fax:805-335-6878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility