Healthcare Provider Details

I. General information

NPI: 1891648879
Provider Name (Legal Business Name): HYDE PARK CONGREGATE LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 E HYDE PARK BLVD
INGLEWOOD CA
90302-2506
US

IV. Provider business mailing address

614 E HYDE PARK BLVD
INGLEWOOD CA
90302-2506
US

V. Phone/Fax

Practice location:
  • Phone: 424-777-1727
  • Fax: 424-777-1737
Mailing address:
  • Phone: 424-777-1727
  • Fax: 424-777-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. ANNA SOGOMONIAN
Title or Position: CEO
Credential:
Phone: 424-777-1727