MEDICARE: RBI INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	306003586	CA

General Provider Information

NPI Number	:	1154710473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RBI INC.

Provider Business Mailing Address
First Line	:	1047 CHEYENNE ST
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2860
Country	:	US
Telephone Number	:	714-662-0546
Fax Number	:	714-617-5121

Provider Business Practice Location Address
First Line	:	1047 CHEYENNE ST
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2860
Country	:	US
Telephone Number	:	714-662-0546
Fax Number	:	714-617-5121

Authorized Official
Title or Position	:	LICENSEE & ADMINISTRATOR
Name	:	MR. ROBERTO CARLOS BOLANOS
Credential	:
Telephone Number	:	714-662-0546

Provider Enumeration Date	:	01/12/2015
Last Update Date	:	01/12/2015

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