NPIMap

Organization Active NPI

Holly House

  • Intellectual Disabilities Intermediate Care Facility
  • Rialto, CA
National Provider Identifier
1801911797
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
HOLLY HOUSE
Practice address
773 E Holly St
Rialto, CA 92376-4520
Phone
(909) 874-7690
Fax
(909) 874-8689
NPI assigned
Mar 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Cheryl Jumonville
Title
Exec Vice President
Phone
(951) 682-4833

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X CA Primary

Addresses

Primary practice location

773 E Holly St
Rialto, CA 92376-4520

Mailing address

3674 Pacific Ave
Riverside, CA 92509-1948
Phone (951) 682-4833

Other identifiers 1

IdentifierTypeStateIssuer
2400000518MedicaidCA

Other names 1

  • VISTA PACIFICA ENTERPRISES Other name

National Provider Directory

National Provider Directory
Tax ID family
Eucalyptus House6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801911797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3674 PACIFIC AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925091948",
            "telephone_number": "951-682-4833",
            "fax_number": "951-682-1503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "773 E HOLLY ST",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923764520",
            "telephone_number": "909-874-7690",
            "fax_number": "909-874-8689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLY HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JUMONVILLE",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "EXEC VICE PRESIDENT",
        "authorized_official_telephone_number": "951-682-4833",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2400000518",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VISTA PACIFICA ENTERPRISES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Rialto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.