Healthcare Provider Details

I. General information

NPI: 1154968055
Provider Name (Legal Business Name): PASADENA CONGREGATE LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 N SUMMIT AVE
PASADENA CA
91103-2655
US

IV. Provider business mailing address

1165 N SUMMIT AVE
PASADENA CA
91103-2655
US

V. Phone/Fax

Practice location:
  • Phone: 818-679-7120
  • Fax: 747-227-3614
Mailing address:
  • Phone: 818-679-7120
  • Fax: 747-227-3614

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: KHACHATUR SARYAN
Title or Position: CEO
Credential: DDS, MS
Phone: 818-631-0770