Provider Demographics
NPI:1194369082
Name:CARNELIAN VILLAS LLC
Entity Type:Organization
Organization Name:CARNELIAN VILLAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JING
Authorized Official - Middle Name:DAISY
Authorized Official - Last Name:STRUVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-395-6037
Mailing Address - Street 1:3117 MARIGOLD CIR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3778
Mailing Address - Country:US
Mailing Address - Phone:818-395-6037
Mailing Address - Fax:
Practice Address - Street 1:1773 S CARNELIAN ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2402
Practice Address - Country:US
Practice Address - Phone:818-395-6037
Practice Address - Fax:818-301-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty