Provider Demographics
NPI:1689653289
Name:13000 VICTORY BOULEVARD, LLC
Entity Type:Organization
Organization Name:13000 VICTORY BOULEVARD, LLC
Other - Org Name:WINDSOR GARDENS HEALTHCARE CENTER OF THE VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ASH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAWLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-385-1090
Mailing Address - Street 1:13000 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-2926
Mailing Address - Country:US
Mailing Address - Phone:818-985-5990
Mailing Address - Fax:818-985-6482
Practice Address - Street 1:13000 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-2926
Practice Address - Country:US
Practice Address - Phone:818-985-5990
Practice Address - Fax:818-985-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA920000079314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05938LMedicaid
CAZZT05938LMedicaid