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Organization
DEL ROSA VILLA, LLC
Active
Organization
DEL ROSA VILLA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH PLOTT TYLER J.D (VICE PRESIDENT OF OPERATIONS)
(323) 655-6960
Entity
Organization
Contact information
Practice address
2018 DEL ROSA AVE, SAN BERNARDINO, CA 92404-5642
(909) 885-3261
(909) 888-3871
Mailing address
5455 WILSHIRE BLVD, SUITE 1925, LOS ANGELES, CA 90036-4201
(323) 655-6960
(323) 655-7122
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
240000029
CA
314000000X
Skilled Nursing Facility
Primary
240000029
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55-5195
MEDICARE ID-TYPE UNSPECIFIED
CA
05
—
LTC90017G
—
CA
Enumeration date
08/03/2005
Last updated
03/05/2015
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