MEDICARE: VALLEY VILLAGE SENIOR 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1982273611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY VILLAGE SENIOR LIVING, INC.

Provider Business Mailing Address
First Line	:	5541 VANTAGE AVE
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2009
Country	:	US
Telephone Number	:	818-731-6635
Fax Number	:	818-960-0227

Provider Business Practice Location Address
First Line	:	5541 VANTAGE AVE
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2009
Country	:	US
Telephone Number	:	818-731-6635
Fax Number	:	818-960-0227

Authorized Official
Title or Position	:	CEO
Name	:	SARGIS AYVAZYAN
Credential	:
Telephone Number	:	818-731-6635

Provider Enumeration Date	:	06/17/2021
Last Update Date	:	06/17/2021

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