Provider Demographics
NPI:1568121549
Name:LAKE ENCINO, INC.
Entity Type:Organization
Organization Name:LAKE ENCINO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAKOP
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-656-8266
Mailing Address - Street 1:340 S LEMON AVE # 9888
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2706
Mailing Address - Country:US
Mailing Address - Phone:323-656-8266
Mailing Address - Fax:866-910-2595
Practice Address - Street 1:2215 W 15TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4703
Practice Address - Country:US
Practice Address - Phone:323-656-8266
Practice Address - Fax:866-910-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness