Organization
LOTUS VILLA AFFILIATE LLC
Active
Other names
Lotus Villa and Memory Care
Organization subpart
No
Provider details
NPI number
Authorized official
EZEQUIEL BERCOVICH (MANAGER)
(213) 948-0913
Entity
Organization
Contact information
Practice address
9448 CITRUS AVE, FONTANA, CA 92335-5512
(909) 355-6887
Mailing address
9448 CITRUS AVE, FONTANA, CA 92335-5512
(909) 355-6887
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
01/13/2023
Last updated
01/13/2023
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