Provider Demographics
NPI:1710358882
Name:IRANIAN JEWISH SENIOR CENTER
Entity Type:Organization
Organization Name:IRANIAN JEWISH SENIOR CENTER
Other - Org Name:BEVERLY HILLS LOVING CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KANANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-652-1323
Mailing Address - Street 1:8764 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1911
Mailing Address - Country:US
Mailing Address - Phone:310-562-1323
Mailing Address - Fax:
Practice Address - Street 1:8764 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1911
Practice Address - Country:US
Practice Address - Phone:310-562-1323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197603601310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA197603601Medicaid