Provider Demographics
NPI:1295393684
Name:RESEDA RANCH
Entity Type:Organization
Organization Name:RESEDA RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RESIDENTIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TETYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNTER
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 1:19013 ARMINTA ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1104
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:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities