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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