Provider Demographics
NPI:1295864569
Name:MOUNTAIN VIEW CHILD CARE, INC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW CHILD CARE, INC
Other - Org Name:LILAC CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKOMPAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-796-6915
Mailing Address - Street 1:1720 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-1727
Mailing Address - Country:US
Mailing Address - Phone:909-796-6915
Mailing Address - Fax:909-796-1285
Practice Address - Street 1:1886 S LILAC CT
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-1759
Practice Address - Country:US
Practice Address - Phone:909-796-6915
Practice Address - Fax:909-796-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80301FMedicaid