Healthcare Provider Details

I. General information

NPI: 1215920871
Provider Name (Legal Business Name): VINCENT-HAYLEY ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 N FAIR OAKS AVE
PASADENA CA
91103-1619
US

IV. Provider business mailing address

1810 N FAIR OAKS AVE
PASADENA CA
91103-1619
US

V. Phone/Fax

Practice location:
  • Phone: 626-398-8182
  • Fax: 626-398-0473
Mailing address:
  • Phone: 626-398-8182
  • Fax: 626-398-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CIPRIANO BAUTISTA JR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-398-8182