MEDICARE: VILLA DEL RIO, INC.

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		CA

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

General Provider Information

NPI Number	:	1366959876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLA DEL RIO, INC.

Provider Business Mailing Address
First Line	:	7002 GAGE AVE
Second Line	:
City	:	BELL GARDENS
State	:	CA
Zip	:	90201-2014
Country	:	US
Telephone Number	:	562-927-6586
Fax Number	:	562-285-9633

Provider Business Practice Location Address
First Line	:	7002 GAGE AVE
Second Line	:
City	:	BELL GARDENS
State	:	CA
Zip	:	90201-2014
Country	:	US
Telephone Number	:	562-927-6586
Fax Number	:	562-285-9633

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	MS. VICKI P ROLLINS
Credential	:	RN
Telephone Number	:	562-426-6141

Provider Enumeration Date	:	01/05/2018
Last Update Date	:	05/04/2021

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