Healthcare Provider Details

I. General information

NPI: 1700025863
Provider Name (Legal Business Name): VISTA COVE CARE CENTER AT RIALTO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 S RIVERSIDE AVE
RIALTO CA
92376-7703
US

IV. Provider business mailing address

1471 S RIVERSIDE AVE
RIALTO CA
92376-7703
US

V. Phone/Fax

Practice location:
  • Phone: 909-877-1361
  • Fax: 909-877-8912
Mailing address:
  • Phone: 909-877-1361
  • Fax: 909-877-8912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BONAPARTE LIU
Title or Position: TREASURER
Credential:
Phone: 949-205-4060