Healthcare Provider Details

I. General information

NPI: 1588087357
Provider Name (Legal Business Name): G V CONGREGATE LIVING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 W AVENUE L8
LANCASTER CA
93536-3405
US

IV. Provider business mailing address

3027 W AVENUE L8
LANCASTER CA
93536-3405
US

V. Phone/Fax

Practice location:
  • Phone: 661-888-5885
  • 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: SYUZANNA MNATSAKANYAN
Title or Position: CFO
Credential:
Phone: 661-888-5885