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General NPI Number Information
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NPI Number | 1447656566
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Entity Type | Organization
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Legal Business Name | PACIFIC VILLA, INC.
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 02/11/2016
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Provider Practice Location Address
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Address Line | 3501 CEDAR AVE
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City | LONG BEACH
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State | CA
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Zip | 90807-3809
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Country | US
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Telephone | 626-331-0781
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Fax | 626-966-7353
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Provider Business Mailing Address
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Address Line | PO BOX 5004
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City | GLENDORA
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State | CA
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Zip | 91740-0019
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Country | US
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Telephone | 626-331-0781
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Fax | 626-966-7353
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MS. VICKI P ROLLINS
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Credential | RN
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Telephone | 626-331-0781
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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 | CA
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