NPIMap

Organization Active NPI

Leisure Village Inc

  • Assisted Living Facility
  • Lake Balboa, CA
National Provider Identifier
1366991135
Registry record updated Sep 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
197607543 Issued in CA
Legal business name
LEISURE VILLAGE INC
Practice address
6728 Gaviota Ave
Lake Balboa, CA 91406-5944
Phone
(818) 585-2200
Fax
(818) 387-6445
NPI assigned
Sep 22, 2016
Last updated
Sep 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Koke Ahankoob
Title
President
Phone
(818) 585-2200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 197607543 CA Primary

Addresses

Primary practice location

6728 Gaviota Ave
Lake Balboa, CA 91406-5944

Mailing address

6728 Gaviota Ave
Lake Balboa, CA 91406-5944
Phone (818) 585-2200

National Provider Directory

National Provider Directory
Tax ID family
Leisure Village Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474502400000",
    "number": "1366991135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6728 GAVIOTA AVE",
            "city": "LAKE BALBOA",
            "state": "CA",
            "postal_code": "914065944",
            "telephone_number": "818-585-2200",
            "fax_number": "818-387-6445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6728 GAVIOTA AVE",
            "city": "LAKE BALBOA",
            "state": "CA",
            "postal_code": "914065944",
            "telephone_number": "818-585-2200",
            "fax_number": "818-387-6445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEISURE VILLAGE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-22",
        "last_updated": "2016-09-22",
        "status": "A",
        "authorized_official_last_name": "AHANKOOB",
        "authorized_official_first_name": "KOKE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-585-2200"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "197607543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Balboa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.