Provider Demographics
NPI:1891352019
Name:MOUNTAIN VIEW CONGREGATE LIVING, INC.
Entity Type:Organization
Organization Name:MOUNTAIN VIEW CONGREGATE LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRIGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDAGAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-786-6927
Mailing Address - Street 1:2165 MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2448
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9001 RIDERWOOD DR
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2628
Practice Address - Country:US
Practice Address - Phone:626-786-6927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities