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NPI Code Detail

MEDICARE: VISTAMESA CONGREGATE HOME, INC.

MEDICARE: VISTAMESA CONGREGATE HOME, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251J00000XNursing Care Agency

General Provider Information

NPI Number : 1316571979
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISTAMESA CONGREGATE HOME, INC.
Provider Business Mailing Address
First Line : 12806 ARMINTA ST
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91605-2018
Country : US
Telephone Number : 818-453-4131
Fax Number :
Provider Business Practice Location Address
First Line : 12806 ARMINTA ST
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91605-2018
Country : US
Telephone Number : 818-453-4131
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. MOVSES JUHARYAN
Credential :
Telephone Number : 818-453-4131
Provider Enumeration Date : 02/23/2020
Last Update Date : 02/23/2020

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Directions to “VISTAMESA CONGREGATE HOME, INC. ” Practice Location

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