Provider Demographics
NPI:1477970416
Name:DIYAVILLA, INC
Entity Type:Organization
Organization Name:DIYAVILLA, INC
Other - Org Name:DIYAMONTE POSTE ACUTE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP.OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TRILOCHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-468-1909
Mailing Address - Street 1:540 W MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3620
Mailing Address - Country:US
Mailing Address - Phone:707-449-3400
Mailing Address - Fax:707-450-0954
Practice Address - Street 1:33 MATEO AVE
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-2037
Practice Address - Country:US
Practice Address - Phone:650-689-5784
Practice Address - Fax:510-991-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000050314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056122Medicare Oscar/Certification