Healthcare Provider Details

I. General information

NPI: 1891177440
Provider Name (Legal Business Name): PALMDALE REGIONAL CONGREGATE LIVING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 CELTIC DR
PALMDALE CA
93551-4596
US

IV. Provider business mailing address

733 CELTIC DR
PALMDALE CA
93551-4596
US

V. Phone/Fax

Practice location:
  • Phone: 818-935-3333
  • 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: ARTAK SARGSYAN
Title or Position: OWNER
Credential:
Phone: 818-935-3333