Provider Demographics
NPI:1508546409
Name:JUDD ASSISTED LIVING
Entity Type:Organization
Organization Name:JUDD ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LIANA
Authorized Official - Middle Name:RAFIKI
Authorized Official - Last Name:AVANESYAN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:747-240-9360
Mailing Address - Street 1:12615 JUDD ST
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-1319
Mailing Address - Country:US
Mailing Address - Phone:747-240-9360
Mailing Address - Fax:747-246-9511
Practice Address - Street 1:12615 JUDD ST
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1319
Practice Address - Country:US
Practice Address - Phone:747-240-9360
Practice Address - Fax:747-246-9511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility