NPIMap

Organization Active NPI

Leisure Village Inc

  • Assisted Living Facility
  • Lake Balboa, CA
National Provider Identifier
1598936205
Registry record updated Mar 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
LEISURE VILLAGE INC
Practice address
6726 Gaviota Ave
Lake Balboa, CA 91406-5944
Phone
(818) 402-7867
Fax
(818) 774-0563
NPI assigned
Mar 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2008

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

Authorized official

Name
Mr. Koke Ahankoob
Title
President
Phone
(818) 402-7867

Specialties & licenses 1

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

Addresses

Primary practice location

6726 Gaviota Ave
Lake Balboa, CA 91406-5944

Mailing address

19528 Ventura Blvd Ste 660
Tarzana, CA 91356-2917
Phone (818) 386-8599

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": "1205971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205971200000",
    "number": "1598936205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19528 VENTURA BLVD STE 660",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913562917",
            "telephone_number": "818-386-8599",
            "fax_number": "818-774-0563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6726 GAVIOTA AVE",
            "city": "LAKE BALBOA",
            "state": "CA",
            "postal_code": "914065944",
            "telephone_number": "818-402-7867",
            "fax_number": "818-774-0563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEISURE VILLAGE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-20",
        "last_updated": "2008-03-20",
        "status": "A",
        "authorized_official_last_name": "AHANKOOB",
        "authorized_official_first_name": "KOKE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-402-7867",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": null,
            "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 Mar 20, 2008; 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.