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General NPI Number Information
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NPI Number | 1043837966
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Entity Type | Organization
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Legal Business Name | DESERT RIDGE TRANSITIONAL CARE CENTER, LP
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 13300 11TH AVENUE
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City | VICTORVILLE
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State | CA
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Zip | 92395
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Country | US
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Telephone | 714-673-6810
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Fax |
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Provider Business Mailing Address
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Address Line | 400 EXCHANGE STE 140
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City | IRVINE
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State | CA
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Zip | 92602-1343
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JOSE LYNCH
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Credential |
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Telephone | 714-673-6810
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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 |
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License Number State |
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