Provider Demographics
NPI:1184186827
Name:SUNLIGHT CONGREGATE LIVING HEALTH FACILITY,INC.
Entity Type:Organization
Organization Name:SUNLIGHT CONGREGATE LIVING HEALTH FACILITY,INC.
Other - Org Name:SUNLIGHT CONGREGATE LIVING HEALTH FACILITY,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKITARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-450-5010
Mailing Address - Street 1:7459 TAMPA AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2468
Mailing Address - Country:US
Mailing Address - Phone:818-450-5010
Mailing Address - Fax:885-588-1303
Practice Address - Street 1:7459 TAMPA AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2468
Practice Address - Country:US
Practice Address - Phone:747-267-5707
Practice Address - Fax:747-666-7914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care