MEDICARE: DEL RIO SANITARIUM, 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	314000000X	Skilled Nursing Facility	940000053	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	206190235	OTHER	CA	OSHPD

General Provider Information

NPI Number	:	1487642336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEL RIO SANITARIUM, INC

Provider Business Mailing Address
First Line	:	7004 E GAGE AVE
Second Line	:
City	:	BELL GARDENS
State	:	CA
Zip	:	90201-2014
Country	:	US
Telephone Number	:	562-927-6586
Fax Number	:	562-928-5097

Provider Business Practice Location Address
First Line	:	7004 E GAGE AVE
Second Line	:
City	:	BELL GARDENS
State	:	CA
Zip	:	90201-2014
Country	:	US
Telephone Number	:	562-927-6586
Fax Number	:	562-928-5097

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ROBERT VILLALUZ
Credential	:
Telephone Number	:	562-927-6586

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	03/08/2016

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