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General NPI Number Information
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NPI Number | 1285113845
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Entity Type | Organization
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Legal Business Name | EASTVALE CONGREGATE CARE
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 6764 BLACK FOREST DR
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City | EASTVALE
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State | CA
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Zip | 92880-3922
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Country | US
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Telephone | 951-268-2150
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Fax | 951-479-5260
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Provider Business Mailing Address
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Address Line | 6764 BLACK FOREST DR
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City | EASTVALE
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State | CA
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Zip | 92880-3922
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Country | US
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Telephone | 951-268-2150
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Fax | 951-479-5260
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Authorized Official
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Title or Position | CEO/ OWNER
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Name | MS. 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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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