Organization
JERRY L. PETTIS VA MEMORIAL HOSPITAL
Active
Organization
JERRY L. PETTIS VA MEMORIAL HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEAN STORDAHL (CEO)
(909) 825-7084
Entity
Organization
Contact information
Practice address
19845 SAN LUIS REY LN, RIVERSIDE, CA 92508-6494
(951) 653-7051
Mailing address
19845 SAN LUIS REY LN, RIVERSIDE, CA 92508-6494
(951) 653-7051
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
219193
CA
Other
Enumeration date
09/22/2007
Last updated
09/22/2007
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