Healthcare Provider Details

I. General information

NPI: 1407489966
Provider Name (Legal Business Name): HOLLYWOOD RCFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 VALLECITO WAY
ANTIOCH CA
94531-9066
US

IV. Provider business mailing address

2495 VALLECITO WAY
ANTIOCH CA
94531-9066
US

V. Phone/Fax

Practice location:
  • Phone: 408-594-9777
  • Fax: 925-775-0526
Mailing address:
  • Phone: 408-594-9777
  • Fax: 925-775-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MARIVIC CRUZ
Title or Position: OWNER
Credential:
Phone: 408-594-9777