Healthcare Provider Details

I. General information

NPI: 1265739577
Provider Name (Legal Business Name): VILLA ESPERANZA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 E VILLA ST
PASADENA CA
91107-2435
US

IV. Provider business mailing address

2060 E VILLA ST
PASADENA CA
91107-2340
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-2919
  • Fax:
Mailing address:
  • Phone: 626-449-2919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number4968
License Number StateCA

VIII. Authorized Official

Name: KELLY WHITE
Title or Position: CEO
Credential: MFC
Phone: 626-449-2919