Healthcare Provider Details

I. General information

NPI: 1194231605
Provider Name (Legal Business Name): MAYANE CONGREGATE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17227 SIMONDS ST
GRANADA HILLS CA
91344-3512
US

IV. Provider business mailing address

17227 SIMONDS ST
GRANADA HILLS CA
91344-3512
US

V. Phone/Fax

Practice location:
  • Phone: 818-292-3213
  • Fax: 844-673-7586
Mailing address:
  • Phone: 818-292-3213
  • Fax: 844-673-7586

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: HRANT HOVHANISSYAN
Title or Position: PRESIDENT
Credential:
Phone: 818-292-3213