Healthcare Provider Details

I. General information

NPI: 1134124415
Provider Name (Legal Business Name): RIVERSIDE CONGREGATIONAL HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 LEMON ST
RIVERSIDE CA
92501-2817
US

IV. Provider business mailing address

3401 LEMON ST
RIVERSIDE CA
92501-2817
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-8202
  • Fax: 951-784-1508
Mailing address:
  • Phone: 951-686-8202
  • Fax: 951-784-1508

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: STUART HARTMAN
Title or Position: V.P. OF OPERATIONS
Credential:
Phone: 562-257-5100