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General NPI Number Information
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NPI Number | 1831305564
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Entity Type | Organization
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Legal Business Name | VILLA ESPERANZA SERVICES
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 427 N CRAIG AVE
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City | PASADENA
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State | CA
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Zip | 91107-2402
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Country | US
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Telephone | 626-795-4925
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Fax |
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Provider Business Mailing Address
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Address Line | 2116 E VILLA ST
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City | PASADENA
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State | CA
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Zip | 91107-2435
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Country | US
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Telephone | 626-449-2919
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | KELLY WHITE
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Credential |
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Telephone | 626-449-2919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 960000776
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License Number State | CA
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