Provider Demographics
NPI:1710637426
Name:ICF LA LLC
Entity Type:Organization
Organization Name:ICF LA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARON
Authorized Official - Middle Name:H
Authorized Official - Last Name:PETROSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-680-0686
Mailing Address - Street 1:6631 CLEON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-2109
Mailing Address - Country:US
Mailing Address - Phone:323-680-0686
Mailing Address - Fax:818-936-0796
Practice Address - Street 1:6631 CLEON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-2109
Practice Address - Country:US
Practice Address - Phone:323-680-0686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities