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General NPI Number Information
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NPI Number | 1790145654
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Entity Type | Organization
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Legal Business Name | BURBANK CONGREGATE LIVING CENTER, INC
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 1100 LELAND WAY
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City | BURBANK
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State | CA
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Zip | 91504-4113
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Country | US
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Telephone | 818-538-5434
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Fax | 818-301-1255
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Provider Business Mailing Address
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Address Line | 1100 LELAND WAY
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City | BURBANK
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State | CA
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Zip | 91504-4113
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Country | US
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Telephone | 818-538-5434
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Fax | 818-301-1255
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Authorized Official
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Title or Position | CEO
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Name | KRISITNE ALEKSANIAN
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Credential |
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Telephone | 818-538-5434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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