Provider Demographics
NPI:1629405220
Name:PALM SPRINGS VILLA, INC.
Entity Type:Organization
Organization Name:PALM SPRINGS VILLA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHSHARUMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-515-7779
Mailing Address - Street 1:68580 TORTUGA RD
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-3875
Mailing Address - Country:US
Mailing Address - Phone:760-515-7779
Mailing Address - Fax:760-841-0982
Practice Address - Street 1:68580 TORTUGA RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3875
Practice Address - Country:US
Practice Address - Phone:760-515-7779
Practice Address - Fax:760-841-0982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility