Provider Demographics
NPI:1295380467
Name:RIVERSIDE ELITE ADVANTAGE CARE HOME LLC
Entity Type:Organization
Organization Name:RIVERSIDE ELITE ADVANTAGE CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING ADMINISTRATOR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-850-1088
Mailing Address - Street 1:31491 SHADOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8213
Mailing Address - Country:US
Mailing Address - Phone:951-850-1088
Mailing Address - Fax:
Practice Address - Street 1:17085 BIRCH HILL RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-8823
Practice Address - Country:US
Practice Address - Phone:951-398-7680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty