Provider Demographics
NPI:1184149692
Name:ROSE GARDEN CONGREGATE LIVING HEALTH FACILITY
Entity type:Organization
Organization Name:ROSE GARDEN CONGREGATE LIVING HEALTH FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARYSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAKHOVETSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-599-5076
Mailing Address - Street 1:18210 KAREN DR
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:924 VIVIAN CIR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-2740
Practice Address - Country:US
Practice Address - Phone:818-599-5076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility