Country Villa Plaza, a Ca LTD. Partnership

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

060000168 Issued in CA

Legal business name

COUNTRY VILLA PLAZA, A CA LTD. PARTNERSHIP

Doing business as

Country Villa Plaza Healthcare Center

Practice address

1209 Hemlock Way
Santa Ana, CA 92707-3609

Phone

(714) 546-1966

Fax

(714) 546-6719

NPI assigned

Sep 2, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Stephen E. Reissman

Title

President of General Partner

Phone

(310) 574-3733

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Country Villa Plaza Healthcare Center Doing business as

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390953600000",
    "number": "1679567853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5120 W GOLDLEAF CIR",
            "address_2": "SUITE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900561292",
            "telephone_number": "310-574-3733",
            "fax_number": "310-574-1322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 HEMLOCK WAY",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927073609",
            "telephone_number": "714-546-1966",
            "fax_number": "714-546-6719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY VILLA PLAZA, A CA LTD. PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-02",
        "last_updated": "2014-01-29",
        "status": "A",
        "authorized_official_last_name": "REISSMAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT OF GENERAL PARTNER",
        "authorized_official_telephone_number": "310-574-3733",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "060000168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05206K",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Villa Plaza Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Victor Cota, PH.D.
• Amy Lee Ann Couch, LCSW
• Irene Rose Coumparoules
• Natalie Coumparoules, LVN
• Council on Aging - Orange County
• County of Orange (HCA-PHS-Family Health Clinic-Dental)
• County of Orange (JCRP)
• County of Orange (HCA-PHS-Lab)
• County of Orange (Orange County Jail Pharmacy)
• County of Orange (Health Care Agency)

• Skilled Nursing Facility in Santa Ana, CA
• Providers in Santa Ana, 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 Jan 29, 2014; 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.