Provider Demographics
NPI:1174413504
Name:NAPA PUEBLO LLC
Entity type:Organization
Organization Name:NAPA PUEBLO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:M
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-806-2443
Mailing Address - Street 1:356 S RIMPAU BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4828
Mailing Address - Country:US
Mailing Address - Phone:323-806-2443
Mailing Address - Fax:
Practice Address - Street 1:1800 PUEBLO AVE
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-4751
Practice Address - Country:US
Practice Address - Phone:323-806-2443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility