MEDICARE: VASS SENIOR 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	:	1841665262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VASS SENIOR CARE

Provider Business Mailing Address
First Line	:	2528 W OAK AVE
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92833-3115
Country	:	US
Telephone Number	:	714-525-2368
Fax Number	:	714-525-2368

Provider Business Practice Location Address
First Line	:	2528 W OAK AVE
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92833-3115
Country	:	US
Telephone Number	:	714-525-2368
Fax Number	:	714-525-2368

Authorized Official
Title or Position	:	OWNER / ADMINISTRATOR
Name	:	MR. AGOSTON VASS
Credential	:
Telephone Number	:	714-624-5277

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	12/10/2015

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