Healthcare Provider Details

I. General information

NPI: 1629965926
Provider Name (Legal Business Name): VSC HBO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 S TUSTIN ST
ORANGE CA
92866-2501
US

IV. Provider business mailing address

393 S TUSTIN ST
ORANGE CA
92866-2501
US

V. Phone/Fax

Practice location:
  • Phone: 714-289-2400
  • Fax: 714-289-2367
Mailing address:
  • Phone: 714-289-2400
  • Fax: 714-289-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBERTA LOUISE CONSOLVER
Title or Position: CEO
Credential: RN
Phone: 714-289-2400