Premiercare 1 Congregate Living, Inc.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

PREMIERCARE 1 CONGREGATE LIVING, INC.

Practice address

3141 Euclid Ave
Lynwood, CA 90262-4971

Phone

(186) 423-6688

NPI assigned

Mar 5, 2017

Last updated

Feb 22, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marilyn Van Nguyen, RN

Title

Ceo/President

Phone

(818) 642-3668

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613952000000",
    "number": "1538609987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5924 E LOS ANGELES AVE STE M",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930635526",
            "telephone_number": "818-642-3668",
            "fax_number": "805-582-0915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3141 EUCLID AVE",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902624971",
            "telephone_number": "186-423-6688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIERCARE 1 CONGREGATE LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-05",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "VAN",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "818-642-3668",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Lynwood, CA
• Providers in Lynwood, CA by specialty
• Assisted Living Facility (Mental Illness) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.