Healthcare Provider Details

I. General information

NPI: 1013227099
Provider Name (Legal Business Name): KND DEVELOPMENT 54, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 MEDICAL CENTER DR
PERRIS CA
92571-2638
US

IV. Provider business mailing address

2224 MEDICAL CENTER DR
PERRIS CA
92571-2638
US

V. Phone/Fax

Practice location:
  • Phone: 951-436-3535
  • Fax:
Mailing address:
  • Phone: 951-436-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: KATHY TEAGUE
Title or Position: VICE PRESIDENT, CORPORATE SECRETARY
Credential:
Phone: 629-253-5121