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General NPI Number Information
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NPI Number | 1639476534
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Entity Type | Organization
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Legal Business Name | AGL VENTURES LLC
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Dates
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Enumeration Date | 02/11/2011
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 79790 BARCELONA DR
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City | LA QUINTA
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State | CA
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Zip | 92253-8818
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Country | US
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Telephone | 760-345-5995
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Fax |
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Provider Business Mailing Address
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Address Line | 79790 BARCELONA DR
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City | LA QUINTA
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State | CA
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Zip | 92253-8818
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Country | US
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Telephone | 760-345-5995
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | MRS. DONNA ELLAMIL-LEJARDE
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Credential |
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Telephone | 760-345-5995
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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 | 336423302
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License Number State | CA
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