Provider Demographics
NPI:1841051554
Name:CONSTANTIN & VIOLETA LLC
Entity type:Organization
Organization Name:CONSTANTIN & VIOLETA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATRICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-280-0380
Mailing Address - Street 1:7241 E COLUMBUS DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4533
Mailing Address - Country:US
Mailing Address - Phone:714-280-0380
Mailing Address - Fax:
Practice Address - Street 1:7241 E COLUMBUS DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4533
Practice Address - Country:US
Practice Address - Phone:714-280-0380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility