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General NPI Number Information
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NPI Number | 1720406762
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Entity Type | Organization
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Legal Business Name | PARADISE CONGREGATE LIVING INC
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Dates
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Enumeration Date | 04/06/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 14822 COHASSET ST
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City | VAN NUYS
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State | CA
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Zip | 91405-1803
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Country | US
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Telephone | 855-747-0777
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Fax |
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Provider Business Mailing Address
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Address Line | 14822 COHASSET ST
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City | VAN NUYS
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State | CA
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Zip | 91405-1803
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Country | US
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Telephone | 855-747-0777
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. LILIANA COHEN
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Credential | MD
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Telephone | 855-747-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 550003206
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License Number State | CA
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