Provider Demographics
NPI:1689828840
Name:LITA & AVA INC.
Entity Type:Organization
Organization Name:LITA & AVA INC.
Other - Org Name:A GRACE SUB ACUTE & SKILLED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAVIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-241-3844
Mailing Address - Street 1:1250 S WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3906
Mailing Address - Country:US
Mailing Address - Phone:408-241-3844
Mailing Address - Fax:408-241-6430
Practice Address - Street 1:1250 S WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3906
Practice Address - Country:US
Practice Address - Phone:408-241-3844
Practice Address - Fax:408-241-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056376Medicare Oscar/Certification