Organization
GREEN RIVER CONGREGATE LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK BONAPARTE MD (MEDICAL DIRECTOR)
(954) 803-0930
Entity
Organization
Contact information
Practice address
2405 INDEPENDENCE CIR, CORONA, CA 92882-5743
(702) 874-4484
Mailing address
1883 W ROYAL HUNTE DR STE 200A, CEDAR CITY, UT 84720-4000
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508260340
—
NY
Enumeration date
06/29/2021
Last updated
06/29/2021
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