MEDICARE: PORTER RANCH 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
2	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1518327477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTER RANCH CONGREGATE LIVING INC

Provider Business Mailing Address
First Line	:	11142 CHIMINEAS AVE
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-2507
Country	:	US
Telephone Number	:	818-233-0970
Fax Number	:	818-671-1871

Provider Business Practice Location Address
First Line	:	11142 CHIMINEAS AVE
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-2507
Country	:	US
Telephone Number	:	818-233-0970
Fax Number	:	818-671-1871

Authorized Official
Title or Position	:	CEO
Name	:	DR. LILIANA COHEN
Credential	:	MD
Telephone Number	:	818-233-0970

Provider Enumeration Date	:	03/04/2016
Last Update Date	:	07/21/2022

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