MEDICARE: VILLA ALEGRE LLC

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
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1528817103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLA ALEGRE LLC

Provider Business Mailing Address
First Line	:	1938 HIDDEN SPRINGS DR
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-3647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1938 HIDDEN SPRINGS DR
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-3647
Country	:	US
Telephone Number	:	619-431-1178
Fax Number	:	619-401-0888

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. DONNAH REY LOCSIN
Credential	:
Telephone Number	:	619-578-8788

Provider Enumeration Date	:	05/15/2024
Last Update Date	:	09/17/2024

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Directions to “VILLA ALEGRE LLC ” Practice Location

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