Provider Demographics
NPI:1891950267
Name:RIVERSIDE EQUITIES LLC
Entity Type:Organization
Organization Name:RIVERSIDE EQUITIES LLC
Other - Org Name:MISSION CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-577-3880
Mailing Address - Street 1:3050 SATURN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6221
Mailing Address - Country:US
Mailing Address - Phone:714-577-3880
Mailing Address - Fax:714-577-3892
Practice Address - Street 1:8487 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3222
Practice Address - Country:US
Practice Address - Phone:951-688-2222
Practice Address - Fax:951-688-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000241314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891950267Medicaid
CA055542Medicare Oscar/Certification