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General NPI Number Information
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NPI Number | 1033861372
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Entity Type | Organization
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Legal Business Name | ASSURED CARE VILLA
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 561 E 2ND AVE
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City | LA HABRA
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State | CA
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Zip | 90631-0820
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Country | US
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Telephone | 562-774-6297
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Fax | 562-381-9333
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Provider Business Mailing Address
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Address Line | 561 E 2ND AVE
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City | LA HABRA
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State | CA
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Zip | 90631-0820
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Country | US
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Telephone | 562-774-6297
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Fax | 562-381-9333
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Authorized Official
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Title or Position | LICENSEE/ADMINISTRATOR
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Name | MRS. THERESA DOMPREH-MENSAH
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Credential |
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Telephone | 562-774-6297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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