Healthcare Provider Details

I. General information

NPI: 1346222098
Provider Name (Legal Business Name): BEN BENNETT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4070 JURUPA AVE
RIVERSIDE CA
92506-2234
US

IV. Provider business mailing address

4070 JURUPA AVE
RIVERSIDE CA
92506-2234
US

V. Phone/Fax

Practice location:
  • Phone: 951-680-6500
  • Fax: 951-680-6504
Mailing address:
  • Phone: 951-680-6500
  • Fax: 951-680-6504

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: MR. BRUCE W BENNETT
Title or Position: PRESIDENT
Credential:
Phone: 951-680-6500