Organization
RENESTER VILLA, LLC
Active
Other names
Blossom Valley Inn Adult Day Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WENDY DEBRA JENSEN (ADMINSTRATOR)
(760) 356-4375
Entity
Organization
Contact information
Practice address
437 GRAPE AVE, HOLTVILLE, CA 92250-1505
(760) 356-4375
(760) 356-4352
Mailing address
708 E 5TH ST, HOLTVILLE, CA 92250-1514
(760) 356-4375
(760) 356-4352
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ADU70412F
—
CA
Enumeration date
05/16/2007
Last updated
06/16/2008
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