Provider Demographics
NPI:1285113845
Name:EASTVALE CONGREGATE CARE
Entity type:Organization
Organization Name:EASTVALE CONGREGATE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:SIHAVONG
Authorized Official - Last Name:VANNOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-847-5476
Mailing Address - Street 1:6764 BLACK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3922
Mailing Address - Country:US
Mailing Address - Phone:951-268-2150
Mailing Address - Fax:951-479-5260
Practice Address - Street 1:6764 BLACK FOREST DR
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3922
Practice Address - Country:US
Practice Address - Phone:951-268-2150
Practice Address - Fax:951-479-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility