Provider Demographics
NPI:1275879652
Name:ADONAI CONGREGATE LIVING, INC.
Entity Type:Organization
Organization Name:ADONAI CONGREGATE LIVING, INC.
Other - Org Name:ADONAI CONGREGATE LIVING INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SYUZANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MNATSAKANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-439-0711
Mailing Address - Street 1:10215 LASAINE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1511
Mailing Address - Country:US
Mailing Address - Phone:818-773-0700
Mailing Address - Fax:818-773-0701
Practice Address - Street 1:10215 LASAINE AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1511
Practice Address - Country:US
Practice Address - Phone:818-773-0700
Practice Address - Fax:818-773-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002504314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275879652OtherMEDICAL