Healthcare Provider Details

I. General information

NPI: 1932574944
Provider Name (Legal Business Name): WESTSIDE CONGREGATE LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6719 QUAKERTOWN AVE
WINNETKA CA
91306-4336
US

IV. Provider business mailing address

6719 QUAKERTOWN AVE
WINNETKA CA
91306-4336
US

V. Phone/Fax

Practice location:
  • Phone: 818-666-3353
  • 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: MARGO GASAMANIAN
Title or Position: CEO
Credential:
Phone: 818-666-3353