Healthcare Provider Details

I. General information

NPI: 1023019700
Provider Name (Legal Business Name): MT. RUBIDOUX CONVALESCENT HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 33RD ST
RIVERSIDE CA
92509-1404
US

IV. Provider business mailing address

5455 WILSHIRE BLVD STE 1925
LOS ANGELES CA
90036-4201
US

V. Phone/Fax

Practice location:
  • Phone: 951-681-2200
  • Fax: 951-681-4402
Mailing address:
  • Phone: 323-655-6960
  • Fax:

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: ELIZABETH PLOTT TYLER
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential: J.D.
Phone: 323-655-6960