Provider Demographics
NPI:1184268302
Name:LSA EXCLUSIVE LLC
Entity type:Organization
Organization Name:LSA EXCLUSIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHABANA
Authorized Official - Middle Name:AZMI
Authorized Official - Last Name:JAMEEL AHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-423-0054
Mailing Address - Street 1:18948 LASSEN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-1835
Mailing Address - Country:US
Mailing Address - Phone:323-423-0054
Mailing Address - Fax:
Practice Address - Street 1:6320 CANOGA AVE STE 1500
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2517
Practice Address - Country:US
Practice Address - Phone:323-423-0054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care