Renester Villa, LLC

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

RENESTER VILLA, LLC

Doing business as

Blossom Valley Inn Adult Day Health Care Center

Practice address

437 Grape Ave
Holtville, CA 92250-1505

Phone

(760) 356-4375

Fax

(760) 356-4352

NPI assigned

May 16, 2007

Last updated

Jun 16, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Wendy Debra Jensen

Title

Adminstrator

Phone

(760) 356-4375

Specialties & licenses 1

Addresses

Other names 1

• Blossom Valley Inn Adult Day Health Care Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Maryrose Bryndzia Delarosa, OTR

  • Occupational Therapist
  • Fort Bragg, NC
  • NPI 1407184484
  NPD (past)

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1154538577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 E 5TH ST",
            "city": "HOLTVILLE",
            "state": "CA",
            "postal_code": "922501514",
            "telephone_number": "760-356-4375",
            "fax_number": "760-356-4352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "437 GRAPE AVE",
            "city": "HOLTVILLE",
            "state": "CA",
            "postal_code": "922501505",
            "telephone_number": "760-356-4375",
            "fax_number": "760-356-4352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENESTER VILLA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "DEBRA",
        "authorized_official_title_or_position": "ADMINSTRATOR",
        "authorized_official_telephone_number": "760-356-4375",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blossom Valley Inn Adult Day Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Benjamin Edward Pettit, RADT
• Raizes
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• Anuj P Shukla, M.S.
• Sonrisa Villa Inc.
• Vincent V. Soun, MD MPH MAJOR

• Adult Day Care Clinic/Center in Holtville, CA
• Providers in Holtville, CA by specialty
• Adult Day Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; 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.