MEDICARE: SUNDANCE COMFORT LIVING INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	164X00000X	Licensed Vocational Nurse
2	251G00000X	Community Based Hospice Care Agency
3	311500000X	Alzheimer Center (Dementia Center)
4	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1356093066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNDANCE COMFORT LIVING INC.

Provider Business Mailing Address
First Line	:	1322 ALAMEDA AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1120
Country	:	US
Telephone Number	:	626-235-2988
Fax Number	:

Provider Business Practice Location Address
First Line	:	68430 RISUENO RD
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-8803
Country	:	US
Telephone Number	:	626-235-2988
Fax Number	:

Authorized Official
Title or Position	:	LVN ADMINISTRATOR
Name	:	VANESSA RICCHIAZZI
Credential	:	LVN
Telephone Number	:	626-235-2988

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	01/24/2022

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