Healthcare Provider Details

I. General information

NPI: 1780239996
Provider Name (Legal Business Name): DCCV.INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9448 KIWI CIR
FOUNTAIN VALLEY CA
92708-5748
US

IV. Provider business mailing address

9448 KIWI CIR
FOUNTAIN VALLEY CA
92708-5748
US

V. Phone/Fax

Practice location:
  • Phone: 714-968-4909
  • Fax:
Mailing address:
  • Phone: 714-968-4909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CLARA HAN
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 714-803-2885