Provider Demographics
NPI:1841729324
Name:GARDEN VILLE HOME CARE LLC
Entity type:Organization
Organization Name:GARDEN VILLE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DULCE
Authorized Official - Middle Name:AMORES
Authorized Official - Last Name:REDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED ADMIN
Authorized Official - Phone:310-528-4033
Mailing Address - Street 1:6206 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2774
Mailing Address - Country:US
Mailing Address - Phone:909-270-3095
Mailing Address - Fax:310-424-7132
Practice Address - Street 1:6206 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2774
Practice Address - Country:US
Practice Address - Phone:909-248-1738
Practice Address - Fax:310-359-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336427615310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility