Organization
VILLA ESPERANZA SERVICES
Active
Organization
VILLA ESPERANZA SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY WHITE MFC (CEO)
(626) 449-2919
Entity
Organization
Contact information
Practice address
2116 E VILLA ST, PASADENA, CA 91107-2435
(626) 449-2919
Mailing address
2060 E VILLA ST, PASADENA, CA 91107-2340
(626) 449-2919
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
4968
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC60466F
—
CA
05
—
LTC60552F
—
CA
Enumeration date
02/23/2011
Last updated
02/23/2011
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