Provider Demographics
NPI:1447767959
Name:VILLA DEL RIO, INC.
Entity Type:Organization
Organization Name:VILLA DEL RIO, INC.
Other - Org Name:VILLA DEL RIO GARDENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:562-426-6141
Mailing Address - Street 1:7002 GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-2014
Mailing Address - Country:US
Mailing Address - Phone:562-927-6586
Mailing Address - Fax:562-285-9633
Practice Address - Street 1:7004 GAGE AVE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-2014
Practice Address - Country:US
Practice Address - Phone:562-426-6141
Practice Address - Fax:562-285-9633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA940000053Medicaid