Organization
LILAC HOLDINGS, LLC
Active
Other names
Reo Vista Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MITCHELL (SECRETARY)
(385) 988-3319
Entity
Organization
Contact information
Practice address
6061 BANBURY ST, SAN DIEGO, CA 92139-3624
(619) 475-2211
(619) 479-5197
Mailing address
262 N UNIVERSITY AVE, FARMINGTON, UT 84025-2975
(385) 518-1814
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255499174
—
CA
05
—
ZZT18684G
—
CA
Enumeration date
12/04/2006
Last updated
08/06/2024
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