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General NPI Number Information
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NPI Number | 1356120307
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Entity Type | Organization
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Legal Business Name | MONTELAGO CONGREGATE LIVING, LLC
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 12537 POINSETTA DR
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City | RIVERSIDE
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State | CA
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Zip | 92503-7067
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Country | US
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Telephone | 909-643-1009
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Fax | 951-643-1031
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Provider Business Mailing Address
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Address Line | 20816 CENTER STREET
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City | RIVERSIDE
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State | CA
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Zip | 92507
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Country | US
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Telephone | 909-643-1009
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Fax | 951-643-1031
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. EARL BONNER
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Credential | RRT/RCT
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Telephone | 951-662-0719
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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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