Healthcare Provider Details

I. General information

NPI: 1497168496
Provider Name (Legal Business Name): RIVERSIDE VILLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 JEFFERSON ST
RIVERSIDE CA
92504-3519
US

IV. Provider business mailing address

3495 JEFFERSON ST
RIVERSIDE CA
92504-3519
US

V. Phone/Fax

Practice location:
  • Phone: 951-687-1617
  • Fax: 951-848-9232
Mailing address:
  • Phone: 951-687-1617
  • Fax: 951-848-9232

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: ARMEN KHRLOBYAN
Title or Position: CEO
Credential:
Phone: 951-687-1617