Lake Balboa Congregate Living

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LAKE BALBOA CONGREGATE LIVING

Practice address

17527 Covello St
Lake Balboa, CA 91406-2320

Phone

(818) 773-0700

NPI assigned

May 29, 2015

Organization subpart

No

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

Authorized official

Name

John Gevorgyan

Title

Ceo

Phone

(818) 773-0700

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1432857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432857600000",
    "number": "1508246034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17527 COVELLO ST",
            "city": "LAKE BALBOA",
            "state": "CA",
            "postal_code": "914062320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17527 COVELLO ST",
            "city": "LAKE BALBOA",
            "state": "CA",
            "postal_code": "914062320",
            "telephone_number": "818-773-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE BALBOA CONGREGATE LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-29",
        "last_updated": "2015-05-29",
        "status": "A",
        "authorized_official_last_name": "GEVORGYAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-773-0700"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosielee Artemese Jones, D.C.
• Luiza Kazaryan, NP
• David Kim, AGACNP-BC
• Andrew Kukla, OTR/L
• Melissa Jean Kullman, LCSW LCS14396
• Terri Lynn Lehrhoff
• Leisure Village Inc
• Leisure Village Inc
• Leisure Village, Inc
• Catherine Levenstein, LCSW

• Skilled Nursing Facility in Lake Balboa, CA
• Providers in Lake Balboa, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2015; 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.