Organization
BELLA VITA CONGREGATE LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SONYA LISETTE HARRELL RN, ACNP-BC (NURSE ADMINISTRATOR/OWNER)
(951) 640-8170
Entity
Organization
Contact information
Practice address
16092 CONSTABLE RD, RIVERSIDE, CA 92504-5664
(951) 800-8435
(951) 429-7162
Mailing address
17130 VAN BUREN BLVD # 134, RIVERSIDE, CA 92504-5905
(951) 800-8435
(951) 429-7162
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
550003868
CA
Other
Enumeration date
07/05/2017
Last updated
07/05/2017
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