# GREEN RIVER CONGREGATE LIVING

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

## Provider details

- **NPI number:** 1427628759
- **Authorized official:** PATRICK BONAPARTE MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (954) 803-0930

## Contact information

- **Practice address:** 2405 INDEPENDENCE CIR, CORONA, CA 92882-5743
- **Practice address phone:** (702) 874-4484
- **Mailing address:** 1883 W ROYAL HUNTE DR STE 200A, CEDAR CITY, UT 84720-4000

## Taxonomy

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

## Other

- **Enumeration date:** 06/29/2021
- **Last updated:** 06/29/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1508260340 | — | NY |