Healthcare Provider Details

I. General information

NPI: 1932004181
Provider Name (Legal Business Name): EDYE SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5358 EL MOLINO AVE
RIVERSIDE CA
92504-2117
US

IV. Provider business mailing address

5358 EL MOLINO AVE
RIVERSIDE CA
92504-2117
US

V. Phone/Fax

Practice location:
  • Phone: 310-493-6584
  • Fax:
Mailing address:
  • Phone: 310-493-6584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number331881847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: