Glen Park at Valley Village

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

License

197603165 Issued in CA

Legal business name

GLEN PARK AT VALLEY VILLAGE

Practice address

5527 Laurel Canyon Blvd
Valley Village, CA 91607-2116

Phone

(818) 769-6626

Fax

(818) 761-2199

NPI assigned

Dec 27, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Tillman Pink Jr.

Title

President

Phone

(818) 769-6626

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Glen Park at Valley 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.

• Laurel Canyon Retirement Community, Inc

  • Assisted Living Facility
  • Valley Village, CA
  • NPI 1093998411
  NPD tax ID

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

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420675200000",
    "number": "1942484837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 MARIPOSA ST",
            "address_2": "LAUREL CANYON RETIREMENT CO GLEN PARK RETIREMENT",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912053245",
            "telephone_number": "818-242-9000",
            "fax_number": "818-242-3972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5527 LAUREL CANYON BLVD",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "916072116",
            "telephone_number": "818-769-6626",
            "fax_number": "818-761-2199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN PARK AT VALLEY VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2015-01-08",
        "status": "A",
        "authorized_official_last_name": "PINK",
        "authorized_official_first_name": "TILLMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-769-6626",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "CA",
            "license": "197603165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RCF00032F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Gilliam
• Gina Deeb D.D.S., a Professional Dental Corporation
• Gittelson Psychology Services
• Myah Tarnow Gittelson, PSY.D.
• Gle Healing Inc
• Go for Help Hospice, Inc.
• Golden Hands Home Health Inc
• Golden State Psychological Services, Inc.
• Peyton Robert Golub
• Stacey Gonzalez

• Alzheimer Center (Dementia Center) in Valley Village, CA
• Providers in Valley Village, CA by specialty
• Alzheimer Center (Dementia Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.