Healthcare Provider Details

I. General information

NPI: 1033431374
Provider Name (Legal Business Name): CENTINELA GRAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 N. PERRIS BLVD.
PERRIS CA
92571-4513
US

IV. Provider business mailing address

2225 N. PERRIS BLVD.
PERRIS CA
92571-4513
US

V. Phone/Fax

Practice location:
  • Phone: 951-657-2135
  • Fax: 951-657-0548
Mailing address:
  • Phone: 951-657-2135
  • Fax: 951-657-0548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number250000222
License Number StateCA

VIII. Authorized Official

Name: MS. VICKI P. ROLLINS
Title or Position: VICE-PRESIDENT
Credential: RN
Phone: 951-657-2135