Provider Demographics
NPI:1003416371
Name:AQUA BELLA RESIDENTIAL CARE
Entity Type:Organization
Organization Name:AQUA BELLA RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MUSARRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAHID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-282-2316
Mailing Address - Street 1:14736 WILLOW GROVE PL
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-5746
Mailing Address - Country:US
Mailing Address - Phone:909-282-2316
Mailing Address - Fax:
Practice Address - Street 1:14736 WILLOW GROVE PL
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-5746
Practice Address - Country:US
Practice Address - Phone:909-282-2316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility