Basic Information
| Provider Information | |||||||||
| NPI: | 1194820712 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VILLAS DE CARLSBAD LTD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LAS VILLAS DE CARLSBAD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9619 CHESAPEAKE DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585654424 | ||||||||
| FaxNumber: | 8585652428 | ||||||||
| Practice Location | |||||||||
| Address1: | 1094 LAGUNA DR | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920081858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604344322 | ||||||||
| FaxNumber: | 7604345967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHANCE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8585654424 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.