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General NPI Number Information
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NPI Number | 1013478973
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Entity Type | Organization
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Legal Business Name | WEST COAST CONGREGATE, INC
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 14905 SANDRA ST
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City | MISSION HILLS
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State | CA
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Zip | 91345-1614
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Country | US
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Telephone | 818-454-0954
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Fax |
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Provider Business Mailing Address
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Address Line | 14905 SANDRA ST
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City | MISSION HILLS
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State | CA
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Zip | 91345-1614
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Country | US
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Telephone | 818-454-0954
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | TADEH DAVUDYAN
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Credential |
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Telephone | 818-454-0954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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