Provider Demographics
NPI:1750650990
Name:FOUR SEASONS ASSISTED LIVING CENTER LLC
Entity Type:Organization
Organization Name:FOUR SEASONS ASSISTED LIVING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-634-1940
Mailing Address - Street 1:12120 CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2002
Mailing Address - Country:US
Mailing Address - Phone:818-487-0770
Mailing Address - Fax:
Practice Address - Street 1:12120 CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-2002
Practice Address - Country:US
Practice Address - Phone:818-487-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191201666310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility