Provider Demographics
NPI:1194296566
Name:MAGNIFIQUE CONGREGATE LIVING INC
Entity type:Organization
Organization Name:MAGNIFIQUE CONGREGATE LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BZNUNI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:323-833-1794
Mailing Address - Street 1:1827 W AVENUE K12
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-6235
Mailing Address - Country:US
Mailing Address - Phone:323-833-1794
Mailing Address - Fax:
Practice Address - Street 1:1827 W AVENUE K12
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-6235
Practice Address - Country:US
Practice Address - Phone:323-833-1794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility