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NPI Code Detail

MEDICARE: PACIFIC VILLA, INC.

MEDICARE: PACIFIC VILLA, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
105-6313OTHERCAPTAN
21447656566OTHERCANPI NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447656566
Entity Type Code : Organization
Provider Name (Legal Business Name) : PACIFIC VILLA, INC.
Provider Business Mailing Address
First Line : PO BOX 5004
Second Line :
City : GLENDORA
State : CA
Zip : 91740-0019
Country : US
Telephone Number : 626-331-0781
Fax Number : 626-966-7353
Provider Business Practice Location Address
First Line : 3501 CEDAR AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-3809
Country : US
Telephone Number : 626-331-0781
Fax Number : 626-966-7353
Authorized Official
Title or Position : VICE-PRESIDENT
Name : MS. VICKI P ROLLINS
Credential : RN
Telephone Number : 626-331-0781
Provider Enumeration Date : 11/17/2014
Last Update Date : 02/11/2016

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Directions to “PACIFIC VILLA, INC. ” Practice Location

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