Virosa, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

550003672 Issued in CA

Legal business name

VIROSA, LLC

Doing business as

Central Valley Congregate Living

Practice address

1051 Tennis LN
Tracy, CA 95376-4417

Phone

(415) 812-2955

NPI assigned

Oct 6, 2016

Organization subpart

No

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

Authorized official

Name

Alex Rudakov

Title

President

Phone

(415) 812-2955

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Central Valley Congregate Living Doing business as

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

{
    "created_epoch": "1475712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475712000000",
    "number": "1659821296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 TENNIS LN",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953764417",
            "telephone_number": "415-812-2955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 TENNIS LN",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953764417",
            "telephone_number": "415-812-2955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIROSA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-06",
        "last_updated": "2016-10-06",
        "status": "A",
        "authorized_official_last_name": "RUDAKOV",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "415-812-2955"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "550003672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "550003672",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY ID",
            "identifier": "630015978",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Valley Congregate Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mimi Ngoc Vo, PHARM.D.

• Skilled Nursing Facility in Tracy, CA
• Providers in Tracy, 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 6, 2016; 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.