Healthcare Provider Details

I. General information

NPI: 1396188397
Provider Name (Legal Business Name): VILLA ESPERANZA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 N CHESTER AVE
PASADENA CA
91104-2946
US

IV. Provider business mailing address

2060 E VILLA ST
PASADENA CA
91107-2340
US

V. Phone/Fax

Practice location:
  • Phone: 626-791-1823
  • Fax: 626-449-2850
Mailing address:
  • Phone: 626-449-2919
  • Fax: 626-449-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAMION LEE
Title or Position: DIRECTOR
Credential:
Phone: 626-449-2919