Provider Demographics
NPI:1376199422
Name:PICO DE LORO, INCORPORATED
Entity Type:Organization
Organization Name:PICO DE LORO, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIEN
Authorized Official - Middle Name:FABELLO
Authorized Official - Last Name:RILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-675-7633
Mailing Address - Street 1:16807 NANDINA AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-8703
Mailing Address - Country:US
Mailing Address - Phone:951-675-7633
Mailing Address - Fax:951-943-8044
Practice Address - Street 1:620 NORTH PERRIS BOULEVARD
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571
Practice Address - Country:US
Practice Address - Phone:951-943-8081
Practice Address - Fax:951-943-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility