Healthcare Provider Details

I. General information

NPI: 1184834483
Provider Name (Legal Business Name): VILLA ESPERANZA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1757 N LAKE AVE
PASADENA CA
91104-1226
US

IV. Provider business mailing address

2116 E VILLA ST
PASADENA CA
91107-2435
US

V. Phone/Fax

Practice location:
  • Phone: 626-398-4435
  • Fax:
Mailing address:
  • Phone: 626-449-2919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: KELLY WHITE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 626-449-2919