# CCW LA JOLLA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Vi at La Jolla Village
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972574507
- **Authorized official:** TOMEK J KOSZYLKO (COUNSEL)
- **Authorized official phone:** (312) 803-8443

## Contact information

- **Practice address:** 4171 LAS PALMAS SQ, SAN DIEGO, CA 92122-6627
- **Practice address phone:** (858) 646-3400
- **Practice address fax:** (858) 646-0064
- **Mailing address:** 233 S WACKER DR STE 8400, CHICAGO, IL 60606-6316
- **Mailing address phone:** (312) 803-8800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 080000751 | CA | Yes |

## Other

- **Enumeration date:** 01/31/2006
- **Last updated:** 10/24/2025