NPIMap

Organization Active NPI

Eisenberg Village of the Los Angeles Jewish Home for the Aging

  • Assisted Living Facility
  • Reseda, CA
National Provider Identifier
1962612432
Registry record updated Aug 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
191201867 Issued in CA
Legal business name
EISENBERG VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING
Practice address
18855 Victory Blvd
Reseda, CA 91335-6445
Phone
(818) 774-3000
NPI assigned
May 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2020

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

Authorized official

Name
Mary M Forrest
Title
Chief Executive Officer
Phone
(818) 774-9208

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 191201867 CA Primary

Addresses

Primary practice location

18855 Victory Blvd
Reseda, CA 91335-6445

Mailing address

18855 Victory Blvd
Reseda, CA 91335-6445
Phone (818) 774-3000

Other identifiers 1

IdentifierTypeStateIssuer
RCF00009FMedicaidCA

Other names 1

  • EISENBERG ALC Other name

National Provider Directory

National Provider Directory
Tax ID family
Eisenberg Village of the Los Angeles Jewish Home for the Aging2 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": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598400000000",
    "number": "1962612432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18855 VICTORY BLVD",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913356445",
            "telephone_number": "818-774-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18855 VICTORY BLVD",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913356445",
            "telephone_number": "818-774-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EISENBERG VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-20",
        "status": "A",
        "authorized_official_last_name": "FORREST",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "818-774-9208"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "191201867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RCF00009F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EISENBERG ALC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "EISENBERG ALC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Reseda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; 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.