Provider Demographics
NPI:1619137155
Name:A AND M HOME CARE VILLA INC
Entity Type:Organization
Organization Name:A AND M HOME CARE VILLA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:ESAU
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:661-943-0021
Mailing Address - Street 1:POB 2348
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-2348
Mailing Address - Country:US
Mailing Address - Phone:661-943-0021
Mailing Address - Fax:661-943-9877
Practice Address - Street 1:6248 WEST AVENUE J-11
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-1716
Practice Address - Country:US
Practice Address - Phone:661-943-0021
Practice Address - Fax:661-943-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197607141310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility