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General NPI Number Information
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NPI Number | 1144965872
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Entity Type | Organization
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Legal Business Name | SILVERLAKE SENIOR HOME
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Dates
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Enumeration Date | 04/27/2022
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 6900 WELLS SPRINGS ST
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City | EASTVALE
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State | CA
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Zip | 91752-3713
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Country | US
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Telephone | 951-847-5476
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Fax |
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Provider Business Mailing Address
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Address Line | 7056 ARCHIBALD AVE # 102-322
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City | EASTVALE
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State | CA
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Zip | 92880-8713
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Country | US
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Telephone | 951-847-5476
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | LESLEY SIHAVONG VANNOY
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Credential |
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Telephone | 951-847-5476
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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 |
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License Number State |
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