Organization
PREMIERCARE 1 CONGREGATE LIVING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN VAN NGUYEN RN (CEO/PRESIDENT)
(818) 642-3668
Entity
Organization
Contact information
Practice address
3141 EUCLID AVE, LYNWOOD, CA 90262-4971
(186) 423-6688
Mailing address
5924 E LOS ANGELES AVE STE M, SIMI VALLEY, CA 93063-5526
(818) 642-3668
(805) 582-0915
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Enumeration date
03/05/2017
Last updated
02/22/2021
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