Provider Demographics
NPI:1992358139
Name:ROMAS PLACE INC
Entity Type:Organization
Organization Name:ROMAS PLACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR AND LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GIL MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-544-3068
Mailing Address - Street 1:5144 JUDSONVILLE DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8501
Mailing Address - Country:US
Mailing Address - Phone:502-544-3068
Mailing Address - Fax:925-848-3704
Practice Address - Street 1:5144 JUDSONVILLE DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8501
Practice Address - Country:US
Practice Address - Phone:502-544-3068
Practice Address - Fax:925-848-3704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility