Provider Demographics
NPI:1083004683
Name:VILLA CELERINA
Entity Type:Organization
Organization Name:VILLA CELERINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MERLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:EVANGELISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-822-3662
Mailing Address - Street 1:19208 SHERYL AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6622
Mailing Address - Country:US
Mailing Address - Phone:562-860-0189
Mailing Address - Fax:562-865-0719
Practice Address - Street 1:19208 SHERYL AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6622
Practice Address - Country:US
Practice Address - Phone:562-860-0189
Practice Address - Fax:562-865-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198205167310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility