Provider Demographics
NPI:1023349271
Name:ADAT SHALOM MANOR
Entity type:Organization
Organization Name:ADAT SHALOM MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:REINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-704-9090
Mailing Address - Street 1:6624 SALE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3628
Mailing Address - Country:US
Mailing Address - Phone:818-704-9090
Mailing Address - Fax:818-704-9696
Practice Address - Street 1:6624 SALE AVE
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-3628
Practice Address - Country:US
Practice Address - Phone:818-704-9090
Practice Address - Fax:818-704-9696
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAT SHALOM BOARD AND CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197602923310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility