Claremont Villa, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

550002511 Issued in CA

Legal business name

CLAREMONT VILLA, INC.

Practice address

13290 Claremont Ave
Victorville, CA 92392-7252

Phone

(760) 596-0977

Fax

(760) 653-5161

NPI assigned

Jun 14, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Garnik Gevorgyan

Title

Ceo

Phone

(760) 596-0977

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445990400000",
    "number": "1124380183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13290 CLAREMONT AVE",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923927252",
            "telephone_number": "760-596-0977",
            "fax_number": "760-653-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13290 CLAREMONT AVE",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923927252",
            "telephone_number": "760-596-0977",
            "fax_number": "760-653-5161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAREMONT VILLA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-14",
        "last_updated": "2015-10-28",
        "status": "A",
        "authorized_official_last_name": "GEVORGYAN",
        "authorized_official_first_name": "GARNIK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-596-0977",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "550002511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124380183",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Victorville, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.