Provider Demographics
NPI:1538338793
Name:GRANCELL VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING
Entity type:Organization
Organization Name:GRANCELL VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-757-3355
Mailing Address - Street 1:7150 TAMPA AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3700
Mailing Address - Country:US
Mailing Address - Phone:818-774-3000
Mailing Address - Fax:
Practice Address - Street 1:7150 TAMPA AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3700
Practice Address - Country:US
Practice Address - Phone:818-774-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000621283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA054147Medicare Oscar/Certification