Healthcare Provider Details

I. General information

NPI: 1992799795
Provider Name (Legal Business Name): INDIO NURSING AND REHABILITATION CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47763 MONROE ST
INDIO CA
92201-6711
US

IV. Provider business mailing address

PO BOX 10487
SAN BERNARDINO CA
92423-0487
US

V. Phone/Fax

Practice location:
  • Phone: 760-347-0750
  • Fax: 760-347-9322
Mailing address:
  • Phone: 909-885-0268
  • Fax: 909-884-1722

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: JEFFERY BLAINE HENDRICKSON
Title or Position: PRESIDENT
Credential:
Phone: 760-347-0750