Healthcare Provider Details

I. General information

NPI: 1336700772
Provider Name (Legal Business Name): RIVERSIDE SNF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17040 ARNOLD DR
RIVERSIDE CA
92518-2813
US

IV. Provider business mailing address

7400 24TH ST
SACRAMENTO CA
95822-5350
US

V. Phone/Fax

Practice location:
  • Phone: 951-697-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RICHARD MARTIN
Title or Position: OWNER
Credential:
Phone: 916-422-4825