Provider Demographics
NPI:1518542851
Name:GARDEN OF PALMS LA, LLC.
Entity Type:Organization
Organization Name:GARDEN OF PALMS LA, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AVRAHAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-896-9400
Mailing Address - Street 1:1025 N FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6102
Mailing Address - Country:US
Mailing Address - Phone:323-656-7900
Mailing Address - Fax:
Practice Address - Street 1:1025 N FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6102
Practice Address - Country:US
Practice Address - Phone:323-656-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility