Provider Demographics
NPI:1043056849
Name:VALLEY CREST MEMORY CARE LLC
Entity type:Organization
Organization Name:VALLEY CREST MEMORY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHLOMO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-217-7877
Mailing Address - Street 1:5967 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2835
Mailing Address - Country:US
Mailing Address - Phone:323-217-7877
Mailing Address - Fax:
Practice Address - Street 1:18524 CORWIN RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2302
Practice Address - Country:US
Practice Address - Phone:760-242-3188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility