Provider Demographics
NPI:1750072484
Name:AVERY GARDEN ASSISTED LIVING- RIVERSIDE
Entity type:Organization
Organization Name:AVERY GARDEN ASSISTED LIVING- RIVERSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-515-9279
Mailing Address - Street 1:7751 STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-5540
Mailing Address - Country:US
Mailing Address - Phone:818-515-9279
Mailing Address - Fax:
Practice Address - Street 1:7675 WOODVIEW ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-5494
Practice Address - Country:US
Practice Address - Phone:818-515-9279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility