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General NPI Number Information
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NPI Number | 1609431998
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Entity Type | Organization
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Legal Business Name | FOUNTAIN VALLEY SENIOR HOMES LLC
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 18561 SANTA ISADORA ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-6212
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Country | US
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Telephone | 949-290-6006
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Fax | 714-982-3433
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Provider Business Mailing Address
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Address Line | 1123 SANDI LN
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City | COSTA MESA
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State | CA
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Zip | 92627-3964
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Country | US
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Telephone | 949-290-6006
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Fax | 714-982-3433
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ULDARICO ALMIRANEZ
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Credential |
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Telephone | 949-290-6006
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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 |
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License Number State |
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