MEDICARE: PLEASANT HILL VILLA HOME CARE

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

General Provider Information

NPI Number	:	1235910746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANT HILL VILLA HOME CARE

Provider Business Mailing Address
First Line	:	3021 PUTNAM BLVD
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-4627
Country	:	US
Telephone Number	:	408-933-8663
Fax Number	:

Provider Business Practice Location Address
First Line	:	3021 PUTNAM BLVD
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-4627
Country	:	US
Telephone Number	:	408-933-8663
Fax Number	:

Authorized Official
Title or Position	:	LICENSEE
Name	:	G;OCEROA MAGAT
Credential	:
Telephone Number	:	408-933-8663

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	10/10/2023

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Practice Location Address:

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