Healthcare Provider Details

I. General information

NPI: 1831748714
Provider Name (Legal Business Name): WINDSOR CYPRESS GARDENS HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 COLORADO AVE
RIVERSIDE CA
92503-2157
US

IV. Provider business mailing address

9200 W SUNSET BLVD PH 7
WEST HOLLYWOOD CA
90069-3601
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-3636
  • Fax:
Mailing address:
  • Phone: 310-385-1090
  • Fax:

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: MR. LEE SAMSON
Title or Position: PRESIDENT
Credential:
Phone: 310-385-1090