MEDICARE: LILAC HOLDINGS, LLC

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	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255499174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILAC HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	262 N UNIVERSITY AVE
Second Line	:
City	:	FARMINGTON
State	:	UT
Zip	:	84025-2975
Country	:	US
Telephone Number	:	385-518-1814
Fax Number	:

Provider Business Practice Location Address
First Line	:	6061 BANBURY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92139-3624
Country	:	US
Telephone Number	:	619-475-2211
Fax Number	:	619-479-5197

Authorized Official
Title or Position	:	SECRETARY
Name	:	JOHN MITCHELL
Credential	:
Telephone Number	:	385-988-3319

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	08/06/2024

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1003811977 — MANOS BANBURY CORPORATION
Practice Location Address:

6061 BANBURY ST
SAN DIEGO, CA
92139-3624

Practice Phone: 619-475-2211
Practice Fax: 619-479-5326

1578004081 — ESMERALDA JOY FLORES MENDOZA N/A
Practice Location Address:

6061 BANBURY ST
SAN DIEGO, CA
92139-3624

Practice Phone: 760-471-0388
Practice Fax:

1548308109 — DR. NGUYEN L LE M.D.
Practice Location Address:

5507 EL CAJON BLVD # B
SAN DIEGO, CA
92115-3624

Practice Phone: 619-582-8814
Practice Fax:

1093857997 — VINCENT LE D.D.S.
Practice Location Address:

5507 EL CAJON BLVD , STE A
SAN DIEGO, CA
92115-3624

Practice Phone: 619-582-5364
Practice Fax: 619-582-1984

1346442985 — TRAM BAO LE MD
Practice Location Address:

5507 EL CAJON BLVD , L
SAN DIEGO, CA
92115-3624

Practice Phone: 619-286-2789
Practice Fax: 619-265-2070

Directions to “LILAC HOLDINGS, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.