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General NPI Number Information
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NPI Number | 1124978135
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Entity Type | Organization
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Legal Business Name | LASSENPARK VILLA INC
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Dates
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Enumeration Date | 01/29/2026
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 364 LASSENPARK CIR
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City | SAN JOSE
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State | CA
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Zip | 95136-2159
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Country | US
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Telephone | 408-477-5522
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Fax | 408-320-2415
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Provider Business Mailing Address
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Address Line | 364 LASSENPARK CIR
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City | SAN JOSE
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State | CA
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Zip | 95136-2159
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Country | US
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Telephone | 408-477-5522
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Fax | 408-320-2415
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | VIRGIL VALIN
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Credential |
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Telephone | 408-477-5522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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