Healthcare Provider Details

I. General information

NPI: 1700186590
Provider Name (Legal Business Name): COMMUNITY CARE REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4070 JURAPA AVE
RIVERSIDE CA
92506-2234
US

IV. Provider business mailing address

3050 SATURN ST STE 201
BREA CA
92821-6221
US

V. Phone/Fax

Practice location:
  • Phone: 951-680-6500
  • Fax: 951-680-6510
Mailing address:
  • Phone: 714-577-3880
  • Fax: 714-577-3892

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: IRVING BAUMAN
Title or Position: OWNER
Credential:
Phone: 714-577-3880