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General NPI Number Information
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NPI Number | 1255340592
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Entity Type | Organization
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Legal Business Name | CRESTVIEW CONVALESCENT HOSPITAL
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 1471 S RIVERSIDE AVE
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City | RIALTO
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State | CA
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Zip | 92376-7703
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Country | US
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Telephone | 909-877-0854
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Fax |
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Provider Business Mailing Address
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Address Line | 1471 S RIVERSIDE AVE
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City | RIALTO
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State | CA
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Zip | 92376-7703
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Country | US
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Telephone | 909-877-0854
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROY V BERGLUND
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Credential | MD
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Telephone | 909-877-1361
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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 | 240000134
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License Number State | CA
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