Healthcare Provider Details

I. General information

NPI: 1902896301
Provider Name (Legal Business Name): RIO HONDO SUBACUTE & NURSING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 E. BEVERLY BLVD.
MONTEBELLO CA
90640-3775
US

IV. Provider business mailing address

273 E. BEVERLY BLVD.
MONTEBELLO CA
90640-3775
US

V. Phone/Fax

Practice location:
  • Phone: 323-724-5100
  • Fax: 323-724-2183
Mailing address:
  • Phone: 323-724-5100
  • Fax: 323-724-2183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000143
License Number StateCA

VIII. Authorized Official

Name: MICHAEL T. BERG
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 505-468-4752