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General NPI Number Information
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NPI Number | 1457974685
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Entity Type | Organization
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Legal Business Name | NORTHRIDGE VILLA FOR ELDERLY INC.
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 8419 YOLANDA AVE
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City | NORTHRIDGE
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State | CA
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Zip | 91324-4753
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Country | US
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Telephone | 818-812-9599
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Fax | 818-671-4705
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Provider Business Mailing Address
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Address Line | 832 CAROLINA CIR
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City | CORONA
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State | CA
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Zip | 92882-6871
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Country | US
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Telephone | 661-526-9670
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Fax |
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | MRS. RONIKA WIJERATHNA
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Credential | RCP
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Telephone | 661-526-9670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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