Healthcare Provider Details

I. General information

NPI: 1467667154
Provider Name (Legal Business Name): VILLA ESPERANZA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 N CRAIG AVE
PASADENA CA
91107-2402
US

IV. Provider business mailing address

2116 E VILLA ST
PASADENA CA
91107-2435
US

V. Phone/Fax

Practice location:
  • Phone: 626-585-8528
  • Fax:
Mailing address:
  • Phone: 626-449-2919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number960000742
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

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