| Organization Name: | PORTER RANCH CONGREGATE LIVING INC |
| NPI Number: | 1518327477 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HASMIK AVETISIAN (CEO) |
| Mailing Address: | 11142 Chimineas Ave Porter Ranch |
| State: | CA US |
| Postal Code: | 913262507 |
| Phone Number: | 8182330970 |
| Fax Number: | 8186711871 |
| NPI Enumeration Date: | 03/04/2016 |
| NPI Last Update Date: | 03/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320700000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Residential Treatment Facility, Physical Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |