Eclc Wake Forest Villa, Inc.

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

License

306001960 Issued in CA

Legal business name

ECLC WAKE FOREST VILLA, INC.

Practice address

233 Wake Forest Rd.
Costa Mesa, CA 92626-6446

Phone

(714) 434-9489

Fax

(949) 642-0622

NPI assigned

Aug 27, 2012

Last updated

Aug 27, 2012By 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

Mrs. Angelita Franco David, R.N.

Title

Administrator

Phone

(714) 434-9489

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1346025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346025600000",
    "number": "1619225570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 WAKE FOREST RD.",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926266446",
            "telephone_number": "714-434-9489",
            "fax_number": "949-642-0622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 WAKE FOREST RD.",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926266446",
            "telephone_number": "714-434-9489",
            "fax_number": "949-642-0622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ECLC WAKE FOREST VILLA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-27",
        "last_updated": "2012-08-27",
        "status": "A",
        "authorized_official_last_name": "DAVID",
        "authorized_official_first_name": "ANGELITA",
        "authorized_official_middle_name": "FRANCO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "714-434-9489",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "CA",
            "license": "306001960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Custodial Care Facility in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Custodial Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; 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.