Healthcare Provider Details

I. General information

NPI: 1710288931
Provider Name (Legal Business Name): SHIMAREE FOSTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 10/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3766 NYE AVE
RIVERSIDE CA
92505-1867
US

IV. Provider business mailing address

PO BOX 494
RIVERSIDE CA
92502-0494
US

V. Phone/Fax

Practice location:
  • Phone: 951-689-2340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberVN231776
License Number StateCA

VIII. Authorized Official

Name: SHIMAREE FOSTER
Title or Position: RN/TREAMENT NURSE/SUPERVISOR
Credential:
Phone: 951-689-2340