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General NPI Number Information
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NPI Number | 1457707655
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Entity Type | Organization
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Legal Business Name | PLAZA VILLAGE SENIOR LIVING
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Dates
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Enumeration Date | 05/06/2016
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Last Update Date | 05/06/2016
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Provider Practice Location Address
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Address Line | 950 L AVE
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City | NATIONAL CITY
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State | CA
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Zip | 91950-3785
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Country | US
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Telephone | 619-474-4844
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Fax |
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Provider Business Mailing Address
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Address Line | 950 L AVE
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City | NATIONAL CITY
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State | CA
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Zip | 91950-3785
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Country | US
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Telephone | 619-474-4844
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOSHUA BULLER
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Credential |
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Telephone | 619-474-4844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 374602972
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License Number State | CA
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