Provider Demographics
NPI:1619976248
Name:BELL VILLA CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:BELL VILLA CARE ASSOCIATES LLC
Other - Org Name:ROSE VILLA HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED AGENT OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:9028 ROSE STREET
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6418
Mailing Address - Country:US
Mailing Address - Phone:562-925-4252
Mailing Address - Fax:562-925-1130
Practice Address - Street 1:9028 ROSE STREET
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6418
Practice Address - Country:US
Practice Address - Phone:562-925-4252
Practice Address - Fax:562-925-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA940000017314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06104KMedicaid
CAZZT06104KMedicaid