Country Villa Hacienda Healthcare Center

LBN: Mountainside Operating Company, Llc
Country Villa Hacienda Healthcare Center is an health care organization with primary practice located at 1311 E Date St , San Bernardino CA 92404-4233. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Skilled Nursing Facility, which is considered as the primary health care specialty. Mountainside Operating Company, Llc can be contacted via phone (909) 882-3316, or through Reissman, Stephen E. via phone (310) 574-3733.

Contact Information

Primary practice address
1311 E Date St San Bernardino CA 92404-4233
Phone: (909) 882-3316
Fax: (909) 882-5126
Website:
Map and Directions
Authorized official contact:
Name: Reissman, Stephen E.
Phone: (310) 574-3733

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Skilled Nursing Facility 314000000X 240000136 California

Profile Details

NPI number 1477547750
LBN Legal business name Mountainside Operating Company, Llc
DBA Doing business as Country Villa Hacienda Healthcare Center
Authorized official Reissman, Stephen E.
Entity Organization
Organization subpart 1 No
Enumeration date Sep 1st, 2005
Last updated Feb 4th, 2014 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1477547750 NPPES
California MEDICAID ZZT06053J

Popular Providers