Healthcare Provider Details

I. General information

NPI: 1366643603
Provider Name (Legal Business Name): MUTUAL CARE MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 COLORADO AVE
RIVERSIDE CA
92503-2157
US

IV. Provider business mailing address

9025 COLORADO AVE
RIVERSIDE CA
92503-2157
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-3636
  • Fax: 951-688-3031
Mailing address:
  • Phone: 951-688-3636
  • Fax: 951-688-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number250000135
License Number StateCA

VIII. Authorized Official

Name: MRS. GRETCHEN REYNOLDS
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 951-688-3636