Provider Demographics
NPI:1881380590
Name:FALLBROOK ASSISTED LIVING
Entity type:Organization
Organization Name:FALLBROOK ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YULIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASATRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-395-9535
Mailing Address - Street 1:6237 FARMDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4121
Mailing Address - Country:US
Mailing Address - Phone:818-395-9535
Mailing Address - Fax:
Practice Address - Street 1:5504 FALLBROOK AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-4326
Practice Address - Country:US
Practice Address - Phone:818-395-9535
Practice Address - Fax:818-691-3409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility