MEDICARE: EAGLE VALLEY CARE CENTRE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	07-00018613	NV

General Provider Information

NPI Number	:	1003941303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE VALLEY CARE CENTRE

Provider Business Mailing Address
First Line	:	1149 FAIR WEATHER CIR
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94518-1939
Country	:	US
Telephone Number	:	925-250-8923
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 E LONG ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89706-3214
Country	:	US
Telephone Number	:	775-883-4449
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AFRODESIA LOPOZ
Credential	:
Telephone Number	:	925-250-8923

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	08/22/2020

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Directions to “EAGLE VALLEY CARE CENTRE ” Practice Location

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