# MT. RUBIDOUX CONVALESCENT HOSPITAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023019700
- **Authorized official:** ELIZABETH PLOTT TYLER J.D. (VICE PRESIDENT OF OPERATIONS)
- **Authorized official phone:** (323) 655-6960

## Contact information

- **Practice address:** 6401 33RD ST, RIVERSIDE, CA 92509-1404
- **Practice address phone:** (951) 681-2200
- **Practice address fax:** (951) 681-4402
- **Mailing address:** 5455 WILSHIRE BLVD, STE 1925, LOS ANGELES, CA 90036-4201
- **Mailing address phone:** (323) 655-6960

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | CA | Yes |

## Other

- **Enumeration date:** 08/03/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT05581I | — | CA |