MEDICARE: VILLA ESPERANZA SERVICES

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	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1396188397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLA ESPERANZA SERVICES

Provider Business Mailing Address
First Line	:	2060 E VILLA ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-2340
Country	:	US
Telephone Number	:	626-449-2919
Fax Number	:	626-449-2850

Provider Business Practice Location Address
First Line	:	1115 N CHESTER AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-2946
Country	:	US
Telephone Number	:	626-791-1823
Fax Number	:	626-449-2850

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DAMION LEE
Credential	:
Telephone Number	:	626-449-2919

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/10/2013

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