Provider Demographics
NPI:1093247470
Name:V & V ENTERPRISES
Entity Type:Organization
Organization Name:V & V ENTERPRISES
Other - Org Name:GRACE'S HOME 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAGALY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTEROS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:714-673-4573
Mailing Address - Street 1:13322 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1945
Mailing Address - Country:US
Mailing Address - Phone:714-673-4573
Mailing Address - Fax:
Practice Address - Street 1:13322 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-1945
Practice Address - Country:US
Practice Address - Phone:714-673-4573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRACE'S HOME 2
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306003832172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty