Provider Demographics
NPI:1841042413
Name:THE COTTAGES OF LAKE BALBOA, INC.
Entity type:Organization
Organization Name:THE COTTAGES OF LAKE BALBOA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-378-7422
Mailing Address - Street 1:6230 WILSHIRE BLVD # 2070
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5126
Mailing Address - Country:US
Mailing Address - Phone:818-378-7422
Mailing Address - Fax:
Practice Address - Street 1:6724 GAVIOTA AVE
Practice Address - Street 2:
Practice Address - City:LAKE BALBOA
Practice Address - State:CA
Practice Address - Zip Code:91406-5944
Practice Address - Country:US
Practice Address - Phone:818-378-7422
Practice Address - Fax:855-225-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility