Provider Demographics
NPI:1639476534
Name:AGL VENTURES LLC
Entity Type:Organization
Organization Name:AGL VENTURES LLC
Other - Org Name:MAJESTIC RESIDENTIAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLAMIL-LEJARDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-345-5995
Mailing Address - Street 1:79790 BARCELONA DR
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-8818
Mailing Address - Country:US
Mailing Address - Phone:760-345-5995
Mailing Address - Fax:
Practice Address - Street 1:79790 BARCELONA DR
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-8818
Practice Address - Country:US
Practice Address - Phone:760-345-5995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336423302310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility