Basic Information
| Provider Information | |||||||||
| NPI: | 1053423749 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | A V ASSOCIATES A CALIFORNIA LIMITED PARTNERSHIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1875 BARTON RD | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923735308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097931382 | ||||||||
| FaxNumber: | 9097986689 | ||||||||
| Practice Location | |||||||||
| Address1: | 1875 BARTON RD | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923735308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097931382 | ||||||||
| FaxNumber: | 9097986689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 08/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | MCDONALD | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9097931382 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 240000323 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | LTC55379F | 05 | CA | MEDICAID |