Provider Demographics
NPI:1164797528
Name:CEDARS ASSISTED LIVING
Entity Type:Organization
Organization Name:CEDARS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERGARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-344-2042
Mailing Address - Street 1:17300 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3902
Mailing Address - Country:US
Mailing Address - Phone:818-344-2042
Mailing Address - Fax:818-344-1892
Practice Address - Street 1:17300 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3902
Practice Address - Country:US
Practice Address - Phone:818-344-2042
Practice Address - Fax:818-344-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197608267310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility