MEDICARE: ALL VALLEY 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	320700000X	Physical Disabilities Residential Treatment Facility
2	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1427418383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL VALLEY CONGREGATE LIVING INC

Provider Business Mailing Address
First Line	:	17404 HORACE ST
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-4719
Country	:	US
Telephone Number	:	818-459-4995
Fax Number	:	818-671-1868

Provider Business Practice Location Address
First Line	:	17404 HORACE ST
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-4719
Country	:	US
Telephone Number	:	818-459-4995
Fax Number	:	818-671-1868

Authorized Official
Title or Position	:	CEO
Name	:	VAL SEREBRYANY
Credential	:
Telephone Number	:	747-300-9396

Provider Enumeration Date	:	03/04/2016
Last Update Date	:	07/29/2020

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