Healthcare Provider Details

I. General information

NPI: 1942537907
Provider Name (Legal Business Name): FLOWER VILLA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 S LA CIENEGA BLVD
LOS ANGELES CA
90035-3715
US

IV. Provider business mailing address

1480 S LA CIENEGA BLVD
LOS ANGELES CA
90035-3715
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-3030
  • Fax: 310-652-0329
Mailing address:
  • Phone: 310-652-3030
  • Fax: 310-652-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number056438
License Number StateCA

VIII. Authorized Official

Name: MS. VICKI P ROLLINS
Title or Position: VICE-PRESIDENT
Credential: RN
Phone: 310-652-3030