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General NPI Number Information
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NPI Number | 1851720486
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Entity Type | Organization
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Legal Business Name | CONGREGATE LIVING HEALTH FACILITY, INC.
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 5440 TUJUNGA AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91601-4967
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Country | US
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Telephone | 805-253-6708
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Fax | 888-640-4414
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Provider Business Mailing Address
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Address Line | 5440 TUJUNGA AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91601-4967
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Country | US
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Telephone | 805-253-6708
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Fax | 888-640-4414
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | MR. LEANDER JACKSON JR.
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Credential |
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Telephone | 805-253-6708
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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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