Healthcare Provider Details

I. General information

NPI: 1245383975
Provider Name (Legal Business Name): VALLEY VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16124 TUPPER ST
NORTH HILLS CA
91343-3048
US

IV. Provider business mailing address

20830 SHERMAN WAY
WINNETKA CA
91306-2707
US

V. Phone/Fax

Practice location:
  • Phone: 818-587-9450
  • Fax: 818-587-9184
Mailing address:
  • Phone: 818-587-9450
  • Fax: 818-587-9184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License NumberLTC60334F
License Number StateCA

VIII. Authorized Official

Name: JOANNE TSCHANTRE
Title or Position: ACCOUNTS RECEIVABLE MANAGER
Credential:
Phone: 818-587-9450