Healthy Life Congregate Care

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

Legal business name

HEALTHY LIFE CONGREGATE CARE

Practice address

3011 Peoria Ave
Simi Valley, CA 93063-1654

Phone

(805) 955-0057

Fax

(805) 728-7454

NPI assigned

Mar 22, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Edmond V Derderyan, MD

Title

Ceo

Phone

(805) 955-0057

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458604800000",
    "number": "1902268758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3011 NORTH PEORIA AVENUE",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "93063",
            "telephone_number": "805-955-0057",
            "fax_number": "805-728-7454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3011 PEORIA AVE",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930631654",
            "telephone_number": "805-955-0057",
            "fax_number": "805-728-7454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY LIFE CONGREGATE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-22",
        "last_updated": "2016-03-22",
        "status": "A",
        "authorized_official_last_name": "DERDERYAN",
        "authorized_official_first_name": "EDMOND",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "805-955-0057",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorna F. Hawley, LCSW
• HCJ Hospice, Inc
• Healing Care Hospice Simi Valley, LLC
• Healing Touch Home Health LLC
• Health Care Professional Inc
• Healthy Senior Care Partners
• Heart Center of Southern California Inc
• Hearten Home Health, Inc.
• Heartlight Healing Collective
• Katherine Heaton, LMFT

• Nursing Facility/Intermediate Care Facility in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Nursing Facility/Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; 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.