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General NPI Number Information
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NPI Number | 1518942143
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Entity Type | Organization
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Legal Business Name | CALIFORNIAN MAGNOLIA CONVALESCENT
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 08/01/2013
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Provider Practice Location Address
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Address Line | 8133 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92504-3409
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Country | US
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Telephone | 951-688-4321
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Fax | 951-352-2768
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Provider Business Mailing Address
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Address Line | 8133 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92504-3409
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Country | US
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Telephone | 951-688-4321
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Fax | 951-352-2768
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MRS. KIMBERLY SUE RICHARDS
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Credential | LIC NURSING HOME ADM
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Telephone | 951-688-4321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number | 250000170
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 250000170
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License Number State | CA
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