Redwood Grove

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

197608204 Issued in CA

Legal business name

REDWOOD GROVE

Practice address

10161 Hillhaven Ave
Tujunga, CA 91042-2229

Phone

(818) 352-1559

NPI assigned

Sep 23, 2014

Last updated

Sep 23, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kourosh Shirazi

Title

VP

Phone

(714) 270-5444

Specialties & licenses 1

Addresses

Tax ID family

Hacienda Village2 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.

• Hacienda Village

  • Adult Mental Health Clinic/Center
  • Riverside, CA
  • NPI 1255579215
  NPD tax ID

Locations

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

{
    "created_epoch": "1411430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411430400000",
    "number": "1760884555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10161 HILLHAVEN AVE",
            "city": "TUJUNGA",
            "state": "CA",
            "postal_code": "910422229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10161 HILLHAVEN AVE",
            "city": "TUJUNGA",
            "state": "CA",
            "postal_code": "910422229",
            "telephone_number": "818-352-1559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDWOOD GROVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-23",
        "last_updated": "2014-09-23",
        "status": "A",
        "authorized_official_last_name": "SHIRAZI",
        "authorized_official_first_name": "KOUROSH",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "714-270-5444"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "CA",
            "license": "197608204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Tujunga, CA
• Providers in Tujunga, CA by specialty
• Assisted Living Facility (Mental Illness) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; 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.