Provider Demographics
NPI:1033861372
Name:ASSURED CARE VILLA
Entity Type:Organization
Organization Name:ASSURED CARE VILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMPREH-MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-774-6297
Mailing Address - Street 1:561 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-0820
Mailing Address - Country:US
Mailing Address - Phone:562-774-6297
Mailing Address - Fax:562-381-9333
Practice Address - Street 1:561 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-0820
Practice Address - Country:US
Practice Address - Phone:562-774-6297
Practice Address - Fax:562-381-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility