Healthcare Provider Details

I. General information

NPI: 1194649228
Provider Name (Legal Business Name): VINTAGE CONGREGATE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18122 VINTAGE ST
NORTHRIDGE CA
91325-1052
US

IV. Provider business mailing address

18122 VINTAGE ST
NORTHRIDGE CA
91325-1052
US

V. Phone/Fax

Practice location:
  • Phone: 818-983-2224
  • 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: HAMAZASP KHUDOYAN
Title or Position: PRESIDENT
Credential:
Phone: 818-983-2224