Country Villa Imperial, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

240000113 Issued in CA

Legal business name

COUNTRY VILLA IMPERIAL, LLC

Doing business as

Healthcare Center of Bella Vista

Practice address

933 E Deodar St
Ontario, CA 91764-1309

Phone

(909) 985-2731

Fax

(909) 985-1414

NPI assigned

Mar 27, 2013

Last updated

Apr 30, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Stephen Reissman

Title

Ceo

Phone

(310) 574-3733

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Healthcare Center of Bella Vista Doing business as

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

{
    "created_epoch": "1364342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367280000000",
    "number": "1699018739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 E DEODAR ST",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917641309",
            "telephone_number": "909-985-2731",
            "fax_number": "909-985-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 E DEODAR ST",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917641309",
            "telephone_number": "909-985-2731",
            "fax_number": "909-985-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY VILLA IMPERIAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-27",
        "last_updated": "2013-04-30",
        "status": "A",
        "authorized_official_last_name": "REISSMAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-574-3733",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "240000113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05693I",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthcare Center of Bella Vista",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Ontario, CA
• Providers in Ontario, 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 Apr 30, 2013; 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.