Provider Demographics
NPI:1770963068
Name:ANGEL OF FAITH CONGREGATE LIVING, INC.
Entity type:Organization
Organization Name:ANGEL OF FAITH CONGREGATE LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LUISITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVANERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-730-4231
Mailing Address - Street 1:8447 WEBB AVE
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8447 WEBB AVE
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3832
Practice Address - Country:US
Practice Address - Phone:818-730-4231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care