Healthcare Provider Details

I. General information

NPI: 1609236561
Provider Name (Legal Business Name): SHERMAN OAKS CONGREGATE LIVING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4637 NAGLE AVE
SHERMAN OAKS CA
91423-3227
US

IV. Provider business mailing address

4637 NAGLE AVE
SHERMAN OAKS CA
91423-3227
US

V. Phone/Fax

Practice location:
  • Phone: 818-878-8528
  • Fax: 818-450-1485
Mailing address:
  • Phone: 818-878-8528
  • Fax: 818-450-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ANNA SAFRAZBEKIAN
Title or Position: CEO
Credential:
Phone: 818-571-4338