NPIMap

Organization Active NPI

Boris Management Corp

Doing business as Country Club North

  • Assisted Living Facility
  • Los Angeles, CA
National Provider Identifier
1407230162
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
197609131 Issued in CA
Legal business name
BORIS MANAGEMENT CORP
Doing business as
Country Club North
Practice address
654 Lillian Way
Los Angeles, CA 90004-1108
Phone
(323) 856-0161
Fax
(323) 464-7041
NPI assigned
Jul 13, 2015
Last updated
Jun 20, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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

Authorized official

Name
Mr. Boris Skuratovich
Title
President
Phone
(323) 610-2841

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 197609131 CA Primary

Addresses

Primary practice location

654 Lillian Way
Los Angeles, CA 90004-1108

Mailing address

654 Lillian Way
Los Angeles, CA 90004-1108
Phone (323) 856-0161

Other names 1

  • Country Club North Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Atwater Village South2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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": "1436745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1407230162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "654 LILLIAN WAY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900041108",
            "telephone_number": "323-856-0161",
            "fax_number": "323-464-7041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "654 LILLIAN WAY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900041108",
            "telephone_number": "323-856-0161",
            "fax_number": "323-464-7041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BORIS MANAGEMENT CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-13",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "SKURATOVICH",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-610-2841",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "197609131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Club North",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.