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General NPI Number Information
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NPI Number | 1154710473
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Entity Type | Organization
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Legal Business Name | RBI INC.
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Dates
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Enumeration Date | 01/12/2015
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 1047 CHEYENNE ST
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City | COSTA MESA
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State | CA
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Zip | 92626-2860
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Country | US
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Telephone | 714-662-0546
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Fax | 714-617-5121
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Provider Business Mailing Address
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Address Line | 1047 CHEYENNE ST
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City | COSTA MESA
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State | CA
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Zip | 92626-2860
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Country | US
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Telephone | 714-662-0546
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Fax | 714-617-5121
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Authorized Official
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Title or Position | LICENSEE & ADMINISTRATOR
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Name | MR. ROBERTO CARLOS BOLANOS
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Credential |
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Telephone | 714-662-0546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 306003586
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License Number State | CA
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