MEDICARE: LOS ANGELES 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	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1790059244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANGELES CONGREGATE LIVING INC.

Provider Business Mailing Address
First Line	:	7819 ARVILLA AVE
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-4314
Country	:	US
Telephone Number	:	323-302-3956
Fax Number	:

Provider Business Practice Location Address
First Line	:	7819 ARVILLA AVE
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-4314
Country	:	US
Telephone Number	:	323-302-3956
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/DPCS
Name	:	MRS. MARIAM VOSKANYAN
Credential	:	RN
Telephone Number	:	323-302-3956

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	03/01/2012

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