Provider Demographics
NPI:1609028869
Name:DELA CRUZ-VERGARA,INC
Entity Type:Organization
Organization Name:DELA CRUZ-VERGARA,INC
Other - Org Name:FOOTHILL MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:VERGARA
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-892-5553
Mailing Address - Street 1:405 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-2715
Mailing Address - Country:US
Mailing Address - Phone:209-892-5553
Mailing Address - Fax:209-892-7723
Practice Address - Street 1:405 S 4TH ST
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-2715
Practice Address - Country:US
Practice Address - Phone:209-892-5553
Practice Address - Fax:209-892-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility