Provider Demographics
NPI:1912369380
Name:FAMILY VILLA HOME CARE, INC.
Entity Type:Organization
Organization Name:FAMILY VILLA HOME CARE, INC.
Other - Org Name:RFL NON EMERGENCY TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:BOLIVAR
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-454-6011
Mailing Address - Street 1:13122 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3842
Mailing Address - Country:US
Mailing Address - Phone:714-600-8559
Mailing Address - Fax:866-412-4929
Practice Address - Street 1:13122 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3842
Practice Address - Country:US
Practice Address - Phone:714-600-8559
Practice Address - Fax:866-412-4929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)