Healthcare Provider Details

I. General information

NPI: 1487196655
Provider Name (Legal Business Name): MEADOWS RIDGE CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E WASHINGTON ST
COLTON CA
92324-4619
US

IV. Provider business mailing address

4032 WILSHIRE BLVD FL 6
LOS ANGELES CA
90010-3405
US

V. Phone/Fax

Practice location:
  • Phone: 909-824-1530
  • Fax: 909-825-9013
Mailing address:
  • Phone: 213-389-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. DAVID FRIEDMAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 213-389-6900