Healthcare Provider Details

I. General information

NPI: 1447656566
Provider Name (Legal Business Name): PACIFIC VILLA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 CEDAR AVE
LONG BEACH CA
90807-3809
US

IV. Provider business mailing address

PO BOX 5004
GLENDORA CA
91740-0019
US

V. Phone/Fax

Practice location:
  • Phone: 626-331-0781
  • Fax: 626-966-7353
Mailing address:
  • Phone: 626-331-0781
  • Fax: 626-966-7353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. VICKI P ROLLINS
Title or Position: VICE-PRESIDENT
Credential: RN
Phone: 626-331-0781