Provider Demographics
NPI:1235137555
Name:AIR FORCE VILLAGE WEST, INC.
Entity Type:Organization
Organization Name:AIR FORCE VILLAGE WEST, INC.
Other - Org Name:AFVW HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ELLIOT
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-697-2201
Mailing Address - Street 1:17050 ARNOLD DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92518-2813
Mailing Address - Country:US
Mailing Address - Phone:951-697-2200
Mailing Address - Fax:951-567-5386
Practice Address - Street 1:17050 ARNOLD DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92518-2855
Practice Address - Country:US
Practice Address - Phone:951-697-2200
Practice Address - Fax:951-567-5386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55-5404Medicare ID - Type Unspecified