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General NPI Number Information
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NPI Number | 1033431374
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Entity Type | Organization
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Legal Business Name | CENTINELA GRAND, INC.
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | 2225 N. PERRIS BLVD.
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City | PERRIS
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State | CA
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Zip | 92571-4513
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Country | US
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Telephone | 951-657-2135
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Fax | 951-657-0548
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Provider Business Mailing Address
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Address Line | 2225 N. PERRIS BLVD.
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City | PERRIS
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State | CA
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Zip | 92571-4513
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Country | US
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Telephone | 951-657-2135
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Fax | 951-657-0548
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MS. VICKI P. ROLLINS
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Credential | RN
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Telephone | 951-657-2135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 250000222
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License Number State | CA
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