Organization
COUNTRY VILLA IMPERIAL, LLC
Active
Other names
Healthcare Center of Bella Vista
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN REISSMAN (CEO)
(310) 574-3733
Entity
Organization
Contact information
Practice address
933 E DEODAR ST, ONTARIO, CA 91764-1309
(909) 985-2731
(909) 985-1414
Mailing address
933 E DEODAR ST, ONTARIO, CA 91764-1309
(909) 985-2731
(909) 985-1414
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
240000113
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05693I
—
CA
Enumeration date
03/27/2013
Last updated
04/30/2013
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