Provider Demographics
NPI:1053892232
Name:MELROSE VILLAS, INC
Entity type:Organization
Organization Name:MELROSE VILLAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERGARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-413-8717
Mailing Address - Street 1:823 N POINSETTIA PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-7623
Mailing Address - Country:US
Mailing Address - Phone:323-746-7840
Mailing Address - Fax:818-927-6066
Practice Address - Street 1:823 N POINSETTIA PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-7623
Practice Address - Country:US
Practice Address - Phone:323-746-7840
Practice Address - Fax:818-927-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197609076310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility