Provider Demographics
NPI:1851272801
Name:CORTLAND CONGREGATE, LLC
Entity type:Organization
Organization Name:CORTLAND CONGREGATE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:CORTLAND
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-397-0658
Mailing Address - Street 1:1637 EL NIDO AVE
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-3700
Mailing Address - Country:US
Mailing Address - Phone:951-404-0531
Mailing Address - Fax:951-465-4594
Practice Address - Street 1:1637 EL NIDO AVE
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-3700
Practice Address - Country:US
Practice Address - Phone:951-404-0531
Practice Address - Fax:951-465-4594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility