Provider Demographics
NPI:1093595142
Name:EAGLE VALLEY CARE CENTRE, LLC
Entity Type:Organization
Organization Name:EAGLE VALLEY CARE CENTRE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AFRODESIA
Authorized Official - Middle Name:CUBETA
Authorized Official - Last Name:LOPOZ
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:925-483-1096
Mailing Address - Street 1:1149 FAIR WEATHER CIR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-1939
Mailing Address - Country:US
Mailing Address - Phone:925-483-1096
Mailing Address - Fax:925-955-9000
Practice Address - Street 1:1807 E LONG ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-3214
Practice Address - Country:US
Practice Address - Phone:925-483-1096
Practice Address - Fax:925-955-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility