Organization
HEALTHY LIFE CONGREGATE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDMOND V DERDERYAN MD (CEO)
(805) 955-0057
Entity
Organization
Contact information
Practice address
3011 PEORIA AVE, SIMI VALLEY, CA 93063-1654
(805) 955-0057
(805) 728-7454
Mailing address
3011 NORTH PEORIA AVENUE, SIMI VALLEY, CA 93063
(805) 955-0057
(805) 728-7454
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
Other
Enumeration date
03/22/2016
Last updated
03/22/2016
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