Provider Demographics
NPI:1255853735
Name:BIJOU HEALTHCARE LLC
Entity Type:Organization
Organization Name:BIJOU HEALTHCARE LLC
Other - Org Name:MEDALLION VILLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:27101 PUERTA REAL STE 450
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8566
Mailing Address - Country:US
Mailing Address - Phone:949-540-1249
Mailing Address - Fax:949-540-1966
Practice Address - Street 1:1719 E BIJOU ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5736
Practice Address - Country:US
Practice Address - Phone:719-381-4972
Practice Address - Fax:719-385-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23R219310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility