Healthcare Provider Details

I. General information

NPI: 1942718853
Provider Name (Legal Business Name): CATHEDRAL CONGREGATE LIVING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68315 RIVIERA RD
CATHEDRAL CITY CA
92234-4843
US

IV. Provider business mailing address

68315 RIVIERA RD
CATHEDRAL CITY CA
92234-4843
US

V. Phone/Fax

Practice location:
  • Phone: 323-823-8828
  • Fax:
Mailing address:
  • Phone: 323-823-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ARUTYUN BALYAN
Title or Position: CEO
Credential:
Phone: 323-823-8828