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General NPI Number Information
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NPI Number | 1053892232
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Entity Type | Organization
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Legal Business Name | MELROSE VILLAS, INC
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 823 N POINSETTIA PL
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City | LOS ANGELES
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State | CA
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Zip | 90046-7623
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Country | US
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Telephone | 323-746-7840
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Fax | 818-927-6066
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Provider Business Mailing Address
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Address Line | 823 N POINSETTIA PL
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City | LOS ANGELES
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State | CA
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Zip | 90046-7623
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Country | US
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Telephone | 323-746-7840
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Fax | 818-927-6066
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KANDICE VERGARA
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Credential |
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Telephone | 310-413-8717
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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 | 197609076
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License Number State | CA
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