Provider Demographics
NPI:1205216017
Name:RED ROBIN NURSING LLC
Entity type:Organization
Organization Name:RED ROBIN NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:BERNARDINE
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:232-509-9037
Mailing Address - Street 1:8335 W SUNSET BLVD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-1500
Mailing Address - Country:US
Mailing Address - Phone:323-509-9037
Mailing Address - Fax:
Practice Address - Street 1:8335 W SUNSET BLVD
Practice Address - Street 2:SUITE #102
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-1500
Practice Address - Country:US
Practice Address - Phone:323-509-9037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health