Healthcare Provider Details

I. General information

NPI: 1285562306
Provider Name (Legal Business Name): SAGEWOOD SENIOR LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 NAGLE AVE
VAN NUYS CA
91401-1801
US

IV. Provider business mailing address

6420 NAGLE AVE
VAN NUYS CA
91401-1801
US

V. Phone/Fax

Practice location:
  • Phone: 559-930-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY DICKRAN GEZALYAN
Title or Position: CEO
Credential:
Phone: 559-930-3600