Provider Demographics
NPI:1013675719
Name:AVANTGARDE SENIOR LIVING OF LA JOLLA
Entity Type:Organization
Organization Name:AVANTGARDE SENIOR LIVING OF LA JOLLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-692-5284
Mailing Address - Street 1:1420 ABBOT KINNEY BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3741
Mailing Address - Country:US
Mailing Address - Phone:818-692-5284
Mailing Address - Fax:818-881-0180
Practice Address - Street 1:6211 LA JOLLA HERMOSA AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-6736
Practice Address - Country:US
Practice Address - Phone:858-456-8619
Practice Address - Fax:818-881-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA374604261OtherRCFE FACILITY LICENSE