Healthcare Provider Details

I. General information

NPI: 1710166558
Provider Name (Legal Business Name): LIFEHOUSE RIVERSIDE OPERATIONS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8781 LAKEVIEW AVE
RIVERSIDE CA
92509-5969
US

IV. Provider business mailing address

8781 LAKEVIEW AVE
RIVERSIDE CA
92509-5969
US

V. Phone/Fax

Practice location:
  • Phone: 951-685-1531
  • Fax: 951-685-4544
Mailing address:
  • Phone: 951-685-1531
  • Fax: 951-685-4544

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. MANEESH BANSAL
Title or Position: CEO
Credential: M.D.
Phone: 562-924-9618