Healthcare Provider Details

I. General information

NPI: 1104226802
Provider Name (Legal Business Name): HEART OF THE VALLEY CONGREGATE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44851 MARIPOSA DR
LANCASTER CA
93536-8375
US

IV. Provider business mailing address

44851 MARIPOSA DR
LANCASTER CA
93536-8375
US

V. Phone/Fax

Practice location:
  • Phone: 818-251-6433
  • Fax: 818-475-5211
Mailing address:
  • Phone:
  • 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: MR. JEFFERSON REYES
Title or Position: CEO/PRESIDENT
Credential:
Phone: 818-251-6433