Provider Demographics
NPI:1578104717
Name:VILLA AMBROSIA, INC
Entity Type:Organization
Organization Name:VILLA AMBROSIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGHIBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-322-1910
Mailing Address - Street 1:1537 BRIGHTON GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-5495
Mailing Address - Country:US
Mailing Address - Phone:714-322-1910
Mailing Address - Fax:866-602-7153
Practice Address - Street 1:1537 BRIGHTON GLEN RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-5495
Practice Address - Country:US
Practice Address - Phone:714-322-1910
Practice Address - Fax:866-602-7153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home