Provider Demographics
NPI:1558089912
Name:HERITAGE CONGREGATE LIVING
Entity Type:Organization
Organization Name:HERITAGE CONGREGATE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAGIK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARUTYUNYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-331-1215
Mailing Address - Street 1:7051 RHEA AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7051 RHEA AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4006
Practice Address - Country:US
Practice Address - Phone:818-331-1215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health