Provider Demographics
NPI:1659261337
Name:CHATSWORTH CONGREGATE LIVING HEALTH FACILITY LLC
Entity type:Organization
Organization Name:CHATSWORTH CONGREGATE LIVING HEALTH FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTADES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-510-4633
Mailing Address - Street 1:4271 UPTOWN NEWPORT DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3096
Mailing Address - Country:US
Mailing Address - Phone:714-657-5777
Mailing Address - Fax:818-510-4648
Practice Address - Street 1:9648 QUAKERTOWN AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-5522
Practice Address - Country:US
Practice Address - Phone:818-510-4633
Practice Address - Fax:818-510-4648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health