MEDICARE: CRI ENTERPRISES, 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	336411237	CA
2	310400000X	Assisted Living Facility	336424160	CA
3	310400000X	Assisted Living Facility	336413251	CA

General Provider Information

NPI Number	:	1306217948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRI ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	3140 E VISTA CHINO
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-5475
Country	:	US
Telephone Number	:	760-799-5424
Fax Number	:

Provider Business Practice Location Address
First Line	:	3140 E VISTA CHINO
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-5475
Country	:	US
Telephone Number	:	760-799-5424
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. GEORGE CAMUA
Credential	:	LVN
Telephone Number	:	760-799-5424

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	05/25/2016

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