Healthcare Provider Details

I. General information

NPI: 1356256796
Provider Name (Legal Business Name): MAGNOLIA CLHF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 MAGNOLIA AVE
RIALTO CA
92377-4064
US

IV. Provider business mailing address

6019 MAGNOLIA AVE
RIALTO CA
92377-4064
US

V. Phone/Fax

Practice location:
  • Phone: 909-572-1905
  • Fax:
Mailing address:
  • Phone:
  • 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: DAVID LIU
Title or Position: CO-OWNER
Credential:
Phone: 626-215-3583