Provider Demographics
NPI:1013032606
Name:GARDENA HOUSE
Entity Type:Organization
Organization Name:GARDENA HOUSE
Other - Org Name:VISTA PACIFICA ENTERPRISES,INC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXEC VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:B
Authorized Official - Last Name:JUMONVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-682-4833
Mailing Address - Street 1:3674 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-1948
Mailing Address - Country:US
Mailing Address - Phone:951-682-4833
Mailing Address - Fax:951-682-1503
Practice Address - Street 1:1041 N GARDENA AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4214
Practice Address - Country:US
Practice Address - Phone:909-874-7690
Practice Address - Fax:909-874-8689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities