Provider Demographics
NPI:1720209042
Name:PROJECT SIX
Entity Type:Organization
Organization Name:PROJECT SIX
Other - Org Name:VALJEAN HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO - PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIRESTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-781-0360
Mailing Address - Street 1:13130 BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6037
Mailing Address - Country:US
Mailing Address - Phone:818-781-0360
Mailing Address - Fax:818-779-5293
Practice Address - Street 1:13130 BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91401-6037
Practice Address - Country:US
Practice Address - Phone:818-781-0360
Practice Address - Fax:818-779-5293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60730FMedicare ID - Type UnspecifiedLONG TERM CARE ID