Provider Demographics
NPI:1457132128
Name:SENIOR LIVING NORWOODS HACIENDA
Entity Type:Organization
Organization Name:SENIOR LIVING NORWOODS HACIENDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINET
Authorized Official - Middle Name:
Authorized Official - Last Name:MANASYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-858-7543
Mailing Address - Street 1:17404 MARTHA ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1323
Mailing Address - Country:US
Mailing Address - Phone:818-858-7543
Mailing Address - Fax:
Practice Address - Street 1:4149 ROLANDO BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-6813
Practice Address - Country:US
Practice Address - Phone:818-858-7543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility