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Organization
HOLLY HOUSE
Active
Organization
HOLLY HOUSE
Active
Other names
VISTA PACIFICA ENTERPRISES
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHERYL JUMONVILLE (EXEC VICE PRESIDENT)
(951) 682-4833
Entity
Organization
Contact information
Practice address
773 E HOLLY ST, RIALTO, CA 92376-4520
(909) 874-7690
(909) 874-8689
Mailing address
3674 PACIFIC AVE, RIVERSIDE, CA 92509-1948
(951) 682-4833
(951) 682-1503
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2400000518
—
CA
Enumeration date
03/20/2007
Last updated
08/22/2020
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