Healthcare Provider Details

I. General information

NPI: 1104851716
Provider Name (Legal Business Name): SOUTH COAST HEALTH & WELLNESS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4768 PALM AVE
RIVERSIDE CA
92501-4012
US

IV. Provider business mailing address

4768 PALM AVE
RIVERSIDE CA
92501-4012
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-9001
  • Fax: 951-686-0148
Mailing address:
  • Phone: 951-686-9001
  • Fax: 951-686-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number250000115
License Number StateCA

VIII. Authorized Official

Name: MRS. CHERYL JUMONVILLE
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 951-686-9001