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General NPI Number Information
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NPI Number | 1982033023
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Entity Type | Organization
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Legal Business Name | VITA GRANDE
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 1493 N MONTEBELLO BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-2586
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Country | US
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Telephone | 626-257-1303
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Fax |
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Provider Business Mailing Address
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Address Line | 1493 N MONTEBELLO BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-2586
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Country | US
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Telephone | 626-257-1303
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. JOYCE MAE B ABIERA
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Credential | RN
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Telephone | 626-257-1303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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