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General NPI Number Information
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NPI Number | 1124380183
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Entity Type | Organization
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Legal Business Name | CLAREMONT VILLA, INC.
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 13290 CLAREMONT AVE
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City | VICTORVILLE
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State | CA
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Zip | 92392-7252
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Country | US
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Telephone | 760-596-0977
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Fax | 760-653-5161
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Provider Business Mailing Address
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Address Line | 13290 CLAREMONT AVE
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City | VICTORVILLE
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State | CA
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Zip | 92392-7252
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Country | US
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Telephone | 760-596-0977
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Fax | 760-653-5161
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Authorized Official
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Title or Position | CEO
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Name | MR. GARNIK GEVORGYAN
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Credential |
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Telephone | 760-596-0977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 550002511
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License Number State | CA
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