MEDICARE: SAN FERNANDO VALLEY ASSOCIATION FOR THE RETARDED

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	315P00000X	Intellectual Disabilities Intermediate Care Facility		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689893893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN FERNANDO VALLEY ASSOCIATION FOR THE RETARDED

Provider Business Mailing Address
First Line	:	15725 PARTHENIA ST
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-4913
Country	:	US
Telephone Number	:	818-894-9301
Fax Number	:	818-894-8841

Provider Business Practice Location Address
First Line	:	15713 PARTHENIA ST APT B
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-7608
Country	:	US
Telephone Number	:	818-894-9301
Fax Number	:	818-894-8841

Authorized Official
Title or Position	:	RESIDENTIAL ADMINISTRATOR
Name	:	ROSCHELL ASHLEY
Credential	:
Telephone Number	:	818-894-9301

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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