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NPI Code Detail

MEDICARE: CITRUS VILLA RETIREMENT CENTER

MEDICARE: CITRUS VILLA RETIREMENT CENTER
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
1310400000XAssisted Living Facility360910569CA

General Provider Information

NPI Number : 1285865469
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITRUS VILLA RETIREMENT CENTER
Provider Business Mailing Address
First Line : 9448 CITRUS AVENUE
Second Line :
City : FONTANA
State : CA
Zip : 92335
Country : US
Telephone Number : 909-823-0631
Fax Number :
Provider Business Practice Location Address
First Line : 9448 CITRUS AVE
Second Line :
City : FONTANA
State : CA
Zip : 92335-5512
Country : US
Telephone Number : 909-823-0631
Fax Number :
Authorized Official
Title or Position : CFO
Name : WILLIAM PRESNELL
Credential :
Telephone Number : 714-577-3880
Provider Enumeration Date : 08/05/2009
Last Update Date : 08/05/2009

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1972083608 — MR. BRADDON CHARLES BENSON OTR/L
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1659935658 — LINDA TERESA WALKER
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Directions to “CITRUS VILLA RETIREMENT CENTER ” Practice Location

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