Provider Demographics
NPI:1558441022
Name:CHINO VALLEY REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:CHINO VALLEY REHABILITATION CENTER LLC
Other - Org Name:CHINO VALLEY HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-389-6900
Mailing Address - Street 1:4032 WILSHIRE BLVD FL6
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3425
Mailing Address - Country:US
Mailing Address - Phone:213-389-6900
Mailing Address - Fax:213-368-8560
Practice Address - Street 1:2351 S TOWNE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-6227
Practice Address - Country:US
Practice Address - Phone:909-628-1245
Practice Address - Fax:909-628-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950000102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05126IMedicaid
CA055126Medicare ID - Type Unspecified