Provider Demographics
NPI:1942718853
Name:CATHEDRAL CONGREGATE LIVING, INC
Entity Type:Organization
Organization Name:CATHEDRAL CONGREGATE LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARUTYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-823-8828
Mailing Address - Street 1:68315 RIVIERA RD
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-4843
Mailing Address - Country:US
Mailing Address - Phone:323-823-8828
Mailing Address - Fax:
Practice Address - Street 1:68315 RIVIERA RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-4843
Practice Address - Country:US
Practice Address - Phone:323-823-8828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility