Provider Demographics
NPI:1518957513
Name:EMBER CARE HLTH CENTER OF PERRIS CALIFORNIA
Entity Type:Organization
Organization Name:EMBER CARE HLTH CENTER OF PERRIS CALIFORNIA
Other - Org Name:EMBER / PLEASANT CARE CORP.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RIVERA
Authorized Official - Last Name:TELLES
Authorized Official - Suffix:
Authorized Official - Credentials:CA, NHA #2035
Authorized Official - Phone:951-657-2135
Mailing Address - Street 1:2225 N PERRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-2580
Mailing Address - Country:US
Mailing Address - Phone:951-657-2135
Mailing Address - Fax:951-657-6145
Practice Address - Street 1:2225 N PERRIS BLVD
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2580
Practice Address - Country:US
Practice Address - Phone:951-657-2135
Practice Address - Fax:951-657-6145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2020-08-22
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
CA22T06186HMedicaid
056186Medicare ID - Type Unspecified