Provider Demographics
NPI:1730873514
Name:ASPEN VILLA
Entity type:Organization
Organization Name:ASPEN VILLA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAMOUTINIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-648-9205
Mailing Address - Street 1:25411 CHAMPLAIN RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5441
Mailing Address - Country:US
Mailing Address - Phone:949-648-9205
Mailing Address - Fax:
Practice Address - Street 1:25411 CHAMPLAIN RD
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5441
Practice Address - Country:US
Practice Address - Phone:949-648-9205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility