# COUNTRY VILLA SERVICE CORP.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** COUNTRY VILLA HEALTH SERVICES
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588997431
- **Authorized official:** MS. CHERYL PETTERSON (VICE PRESIDENT - CAMS)
- **Authorized official phone:** (310) 574-3733

## Contact information

- **Practice address:** 5120 W GOLDLEAF CIR STE 400, LOS ANGELES, CA 90056-1297
- **Practice address phone:** (310) 574-3733
- **Mailing address:** 5120 W GOLDLEAF CIR STE 400, LOS ANGELES, CA 90056-1297
- **Mailing address phone:** (310) 574-3733

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | CA | Yes |

## Other

- **Enumeration date:** 09/10/2009
- **Last updated:** 09/10/2009