Healthcare Provider Details

I. General information

NPI: 1407831118
Provider Name (Legal Business Name): RIVIERA NURSING & CONVALESCENT HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8203 TELEGRAPH RD
PICO RIVERA CA
90660-4905
US

IV. Provider business mailing address

8203 TELEGRAPH RD
PICO RIVERA CA
90660-4905
US

V. Phone/Fax

Practice location:
  • Phone: 562-806-2576
  • Fax: 562-806-1496
Mailing address:
  • Phone: 562-806-2576
  • Fax: 562-806-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000144
License Number StateCA

VIII. Authorized Official

Name: MR. DOV JACOBS
Title or Position: ADMINISTRATOR
Credential:
Phone: 562-806-2576