Healthcare Provider Details

I. General information

NPI: 1245958214
Provider Name (Legal Business Name): VILLA DE ANZA HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5881 EL PALOMINO DR
RIVERSIDE CA
92509-7006
US

IV. Provider business mailing address

5881 EL PALOMINO DR
RIVERSIDE CA
92509-7006
US

V. Phone/Fax

Practice location:
  • Phone: 951-685-3333
  • Fax: 562-278-0354
Mailing address:
  • Phone: 951-685-3333
  • Fax: 562-278-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ADAM ZENOU
Title or Position: CEO
Credential:
Phone: 951-685-3333