Healthcare Provider Details

I. General information

NPI: 1528656089
Provider Name (Legal Business Name): ROLLING GREEN SENIOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2021
Last Update Date: 01/09/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42007 THOROUGHBRED LN
MURRIETA CA
92562-6105
US

IV. Provider business mailing address

1541 OXFORD CT
WEST COVINA CA
91791-4044
US

V. Phone/Fax

Practice location:
  • Phone: 626-893-7804
  • Fax:
Mailing address:
  • Phone: 626-893-7804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GERTRUDE OKORO
Title or Position: PRESIDENT
Credential:
Phone: 626-893-7804