Provider Demographics
NPI:1407489966
Name:HOLLYWOOD RCFE, LLC
Entity Type:Organization
Organization Name:HOLLYWOOD RCFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIVIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:408-594-9777
Mailing Address - Street 1:2306 HOLLYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-1626
Mailing Address - Country:US
Mailing Address - Phone:408-594-9777
Mailing Address - Fax:916-573-3874
Practice Address - Street 1:2306 HOLLYWOOD DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-1626
Practice Address - Country:US
Practice Address - Phone:408-594-9777
Practice Address - Fax:916-573-3874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility