Healthcare Provider Details

I. General information

NPI: 1619294899
Provider Name (Legal Business Name): RAMONA MANOR CONVALESCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 W JOHNSTON AVE
HEMET CA
92543-7012
US

IV. Provider business mailing address

485 W JOHNSTON AVE
HEMET CA
92543-7012
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-0011
  • Fax: 951-658-1457
Mailing address:
  • Phone: 951-652-0011
  • Fax: 951-658-1457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number250000190
License Number StateCA

VIII. Authorized Official

Name: MR. MARK MILLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 951-652-0011