Healthcare Provider Details

I. General information

NPI: 1952190076
Provider Name (Legal Business Name): CERRITOS CONGREGATE LIVING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13118 CANTRECE LN
CERRITOS CA
90703-6131
US

IV. Provider business mailing address

13118 CANTRECE LN
CERRITOS CA
90703-6131
US

V. Phone/Fax

Practice location:
  • Phone: 818-644-2187
  • Fax:
Mailing address:
  • Phone:
  • 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: SHEENA ROSS VALETE
Title or Position: OWNER
Credential:
Phone: 818-644-2187