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General NPI Number Information
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NPI Number | 1083873376
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER VILLA INC
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 135 S AVE 54
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City | LOS ANGELES
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State | CA
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Zip | 90042-4509
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Country | US
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Telephone | 323-257-4754
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Fax |
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Provider Business Mailing Address
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Address Line | 135 S AVE 54
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City | LOS ANGELES
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State | CA
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Zip | 90042
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Country | US
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Telephone | 323-257-4754
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ELENITA PAGUIRIGAN
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Credential |
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Telephone | 323-257-4754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 197606897
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License Number State | CA
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