Healthcare Provider Details

I. General information

NPI: 1740124205
Provider Name (Legal Business Name): KITTRIDGE CONGREGATE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20702 KITTRIDGE ST
WINNETKA CA
91306-4023
US

IV. Provider business mailing address

20702 KITTRIDGE ST
WINNETKA CA
91306-4023
US

V. Phone/Fax

Practice location:
  • Phone: 818-854-6745
  • Fax:
Mailing address:
  • Phone: 818-854-6745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: REGINA REYES
Title or Position: ADMINISTRATOR/VP
Credential:
Phone: 310-489-4476