Provider Demographics
NPI:1710166558
Name:LIFEHOUSE RIVERSIDE OPERATIONS, LLC.
Entity Type:Organization
Organization Name:LIFEHOUSE RIVERSIDE OPERATIONS, LLC.
Other - Org Name:RIVERSIDE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MANEESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BANSAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-924-9618
Mailing Address - Street 1:8781 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-5969
Mailing Address - Country:US
Mailing Address - Phone:951-685-1531
Mailing Address - Fax:951-685-4544
Practice Address - Street 1:8781 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-5969
Practice Address - Country:US
Practice Address - Phone:951-685-1531
Practice Address - Fax:951-685-4544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEHOUSE HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-29
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555330Medicare Oscar/Certification
555330Medicare Oscar/Certification