Healthcare Provider Details

I. General information

NPI: 1750785572
Provider Name (Legal Business Name): VILLA CAMILLA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 E 9TH ST
LONG BEACH CA
90813-4611
US

IV. Provider business mailing address

723 E 9TH ST
LONG BEACH CA
90813-4611
US

V. Phone/Fax

Practice location:
  • Phone: 562-491-2797
  • Fax: 562-491-0945
Mailing address:
  • Phone: 562-491-2797
  • Fax: 562-491-0945

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: MATTHEW KARP
Title or Position: MANAGING MEMBER
Credential:
Phone: 323-974-2606