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General NPI Number Information
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NPI Number | 1487187399
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Entity Type | Organization
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Legal Business Name | VIVA CARE RCFE INC 1
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 3039 CEDAR ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-2522
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Country | US
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Telephone | 805-701-3087
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Fax |
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Provider Business Mailing Address
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Address Line | 2489 SERRANO ROAD
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City | SAN BERNARDINO
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State | CA
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Zip | 92405
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Country | US
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Telephone | 805-701-3087
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MEIJUAN YUAN
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Credential |
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Telephone | 805-701-3087
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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 | 366427407
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License Number State | CA
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