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Organization
MOUNTAINSIDE OPERATING COMPANY, LLC
Active
Organization
MOUNTAINSIDE OPERATING COMPANY, LLC
Active
Other names
Country Villa Hacienda Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN E. REISSMAN (TRUSTEE OF MANAGING MEMBER)
(310) 574-3733
Entity
Organization
Contact information
Practice address
1311 E DATE ST, SAN BERNARDINO, CA 92404-4233
(909) 882-3316
(909) 882-5126
Mailing address
5120 W GOLDLEAF CIR, SUITE 400, LOS ANGELES, CA 90056-1292
(310) 574-3733
(310) 574-1322
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
240000136
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT06053J
—
CA
Enumeration date
09/01/2005
Last updated
02/04/2014
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