Provider Demographics
NPI:1588219521
Name:CREST VILLA LLC
Entity type:Organization
Organization Name:CREST VILLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:RAMASAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-214-4004
Mailing Address - Street 1:PO BOX 7542
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-8085
Mailing Address - Country:US
Mailing Address - Phone:909-214-4004
Mailing Address - Fax:
Practice Address - Street 1:4014 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-1702
Practice Address - Country:US
Practice Address - Phone:951-268-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility