Provider Demographics
NPI:1356093066
Name:SUNDANCE COMFORT LIVING INC.
Entity Type:Organization
Organization Name:SUNDANCE COMFORT LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCHIAZZI
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:626-235-2988
Mailing Address - Street 1:1322 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1120
Mailing Address - Country:US
Mailing Address - Phone:626-235-2988
Mailing Address - Fax:
Practice Address - Street 1:68430 RISUENO RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-8803
Practice Address - Country:US
Practice Address - Phone:626-235-2988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community Based
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)