Provider Demographics
NPI:1790145654
Name:BURBANK CONGREGATE LIVING CENTER, INC
Entity Type:Organization
Organization Name:BURBANK CONGREGATE LIVING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISITNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEKSANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-538-5434
Mailing Address - Street 1:1100 LELAND WAY
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4113
Mailing Address - Country:US
Mailing Address - Phone:818-538-5434
Mailing Address - Fax:818-301-1255
Practice Address - Street 1:1100 LELAND WAY
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4113
Practice Address - Country:US
Practice Address - Phone:818-538-5434
Practice Address - Fax:818-301-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness