1306065511 NPI number — SAN FERNANDO VALLEY ASSOCIATION FOR THE RETARDED

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306065511 NPI number — SAN FERNANDO VALLEY ASSOCIATION FOR THE RETARDED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN FERNANDO VALLEY ASSOCIATION FOR THE RETARDED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306065511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15725 PARTHENIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91343-4913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-894-9301
Provider Business Mailing Address Fax Number:
818-894-8841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15746 PARTHENIA ST APT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91343-7613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-894-9301
Provider Business Practice Location Address Fax Number:
818-894-8841
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ASHLEY
Authorized Official First Name:
ROSCHELL
Authorized Official Middle Name:
Authorized Official Title or Position:
RESIDENTIAL ADMINISTRATOR
Authorized Official Telephone Number:
818-894-9301

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LTC60445F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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