Healthcare Provider Details

I. General information

NPI: 1114318854
Provider Name (Legal Business Name): THE RESIDENCES AT ROYAL BELLINGHAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12229 CHANDLER BLVD
VALLEY VILLAGE CA
91607-4395
US

IV. Provider business mailing address

12229 CHANDLER BLVD
VALLEY VILLAGE CA
91607-4395
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-2997
  • Fax: 818-506-0364
Mailing address:
  • Phone: 818-980-2997
  • Fax: 818-506-0364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number197608129
License Number StateCA

VIII. Authorized Official

Name: MR. LITO VITUG
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 818-980-2997