Provider Demographics
NPI:1558190850
Name:MARALIT RESIDENTIAL VILLA INC.
Entity type:Organization
Organization Name:MARALIT RESIDENTIAL VILLA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARALIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-454-0677
Mailing Address - Street 1:1301 N BIRCHNELL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1003
Mailing Address - Country:US
Mailing Address - Phone:626-454-0677
Mailing Address - Fax:
Practice Address - Street 1:1301 N BIRCHNELL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1003
Practice Address - Country:US
Practice Address - Phone:626-454-0677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility