Provider Demographics
NPI:1164640793
Name:SAN FERNANDO VALLEY ASSOCIATION FOR THE RETARDED
Entity Type:Organization
Organization Name:SAN FERNANDO VALLEY ASSOCIATION FOR THE RETARDED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENTIAL ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROSCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-894-9301
Mailing Address - Street 1:15725 PARTHENIA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-4913
Mailing Address - Country:US
Mailing Address - Phone:818-894-9301
Mailing Address - Fax:818-894-8841
Practice Address - Street 1:15713 PARTHENIA ST APT A
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-7607
Practice Address - Country:US
Practice Address - Phone:818-894-9301
Practice Address - Fax:818-894-8841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60382FMedicaid