MEDICARE: BEN CONGREGATE LIVING INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1417297169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEN CONGREGATE LIVING INC

Provider Business Mailing Address
First Line	:	6622 BEN AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1511
Country	:	US
Telephone Number	:	818-765-7064
Fax Number	:	818-765-7067

Provider Business Practice Location Address
First Line	:	6622 BEN AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1511
Country	:	US
Telephone Number	:	818-765-7064
Fax Number	:	818-765-7067

Authorized Official
Title or Position	:	CEO
Name	:	VARDAN ASIKIAN
Credential	:
Telephone Number	:	818-765-7064

Provider Enumeration Date	:	02/17/2013
Last Update Date	:	02/17/2013

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