Provider Demographics
NPI:1629855606
Name:LUXURY ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:LUXURY ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALYSHEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-225-8181
Mailing Address - Street 1:2036 W MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1113
Mailing Address - Country:US
Mailing Address - Phone:415-225-8181
Mailing Address - Fax:
Practice Address - Street 1:22901 MEYLER AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2819
Practice Address - Country:US
Practice Address - Phone:415-225-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility