MEDICARE: WYANDOTTE VILLA

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1871347146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYANDOTTE VILLA

Provider Business Mailing Address
First Line	:	11120 WYANDOTTE ST
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-5058
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11120 WYANDOTTE ST
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-5058
Country	:	US
Telephone Number	:	818-210-7071
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARGARIT SARKISYAN
Credential	:
Telephone Number	:	818-210-7071

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	04/15/2024

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Directions to “WYANDOTTE VILLA ” Practice Location

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