Mountainside Operating Company, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

240000136 Issued in CA

Legal business name

MOUNTAINSIDE OPERATING COMPANY, LLC

Doing business as

Country Villa Hacienda Healthcare Center

Practice address

1311 E Date St
San Bernardino, CA 92404-4233

Phone

(909) 882-3316

Fax

(909) 882-5126

NPI assigned

Sep 1, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Stephen E. Reissman

Title

Trustee of Managing Member

Phone

(310) 574-3733

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Country Villa Hacienda Healthcare Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391472000000",
    "number": "1477547750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5120 W GOLDLEAF CIR",
            "address_2": "SUITE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900561292",
            "telephone_number": "310-574-3733",
            "fax_number": "310-574-1322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 E DATE ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044233",
            "telephone_number": "909-882-3316",
            "fax_number": "909-882-5126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINSIDE OPERATING COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-01",
        "last_updated": "2014-02-04",
        "status": "A",
        "authorized_official_last_name": "REISSMAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "TRUSTEE OF MANAGING MEMBER",
        "authorized_official_telephone_number": "310-574-3733",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "240000136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT06053J",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Villa Hacienda Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sakari Moss
• Bryan Mota
• Mariana Concepcion Moualem, FNP
• Mountain Right to Life
• Mountain View Transitional LLC
• Avronia Mourkus, DO
• George Mousa, MD
• Salah Mousa
• Noelle Mowles, MS
• Jose Antonio Moya

• Skilled Nursing Facility in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.