1427399633 NPI number — CENTURY VILLA, INC.

Table of content: (NPI 1427399633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427399633 NPI number — CENTURY VILLA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTURY VILLA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427399633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 CENTINELA AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INGLEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-323-8270
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 W ARROW HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91740-5413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-323-8270
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ROLLINS
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
714-323-8270

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LTC55368H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 206190106 . This is a "OSHPD NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 555368 . This is a "MEDICARE PTN" identifier . This identifiers is of the category "OTHER".




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