# RODEO CONGREGATE LIVING, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811410707
- **Authorized official:** GARNIK GEVORGYAN (CEO)
- **Authorized official phone:** (760) 991-5559

## Contact information

- **Practice address:** 14638 RODEO DR, VICTORVILLE, CA 92395-4133
- **Practice address phone:** (760) 991-5559
- **Practice address fax:** (818) 670-7868
- **Mailing address:** 14638 RODEO DR, VICTORVILLE, CA 92395-4133

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 07/21/2017
- **Last updated:** 07/21/2017