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General NPI Number Information
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NPI Number | 1366934663
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Entity Type | Organization
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Legal Business Name | ROYAL CONGREGATE LIVING LLC
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 11/21/2018
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Provider Practice Location Address
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Address Line | 7354 DE SOTO AVE
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City | CANOGA PARK
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State | CA
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Zip | 91303-1703
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Country | US
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Telephone | 818-657-7309
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Fax |
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Provider Business Mailing Address
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Address Line | 5530 CORBIN AVE STE 112
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City | TARZANA
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State | CA
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Zip | 91356-6048
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSIE STA MARIA
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Credential |
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Telephone | 818-456-2464
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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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