Healthcare Provider Details

I. General information

NPI: 1487412391
Provider Name (Legal Business Name): ROSE VALLEY ALTADENA I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 SANTA ANITA AVE
ALTADENA CA
91001-2916
US

IV. Provider business mailing address

150 N SANTA ANITA AVE STE 300
ARCADIA CA
91006-3116
US

V. Phone/Fax

Practice location:
  • Phone: 626-714-7323
  • Fax:
Mailing address:
  • Phone: 626-272-9058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DANIEL KUO
Title or Position: MANAGING MEMBER
Credential:
Phone: 626-272-9058