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General NPI Number Information
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NPI Number | 1972024420
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Entity Type | Organization
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Legal Business Name | BELLA VITA CONGREGATE LIVING, LLC
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 07/05/2017
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Provider Practice Location Address
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Address Line | 16092 CONSTABLE RD
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City | RIVERSIDE
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State | CA
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Zip | 92504-5664
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Country | US
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Telephone | 951-800-8435
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Fax | 951-429-7162
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Provider Business Mailing Address
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Address Line | 17130 VAN BUREN BLVD # 134
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City | RIVERSIDE
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State | CA
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Zip | 92504-5905
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Country | US
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Telephone | 951-800-8435
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Fax | 951-429-7162
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Authorized Official
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Title or Position | NURSE ADMINISTRATOR/OWNER
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Name | MRS. SONYA LISETTE HARRELL
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Credential | RN, ACNP-BC
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Telephone | 951-640-8170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 550003868
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License Number State | CA
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