NPIMap

Organization Active NPI

Eagel Time Care Facility

  • Lodging Provider
  • Riverside, CA
National Provider Identifier
1922768431
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Lodging ProviderTaxonomy code 177F00000X
Legal business name
EAGEL TIME CARE FACILITY
Practice address
1622 Palermo Dr
Riverside, CA 92507-2393
Phone
(562) 685-4610
NPI assigned
Dec 23, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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

Authorized official

Name
Mr. Juan CornellNPI 1790265650
Title
Administrator
Phone
(562) 685-4610

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Lodging Provider 177F00000X Primary

Addresses

Primary practice location

1622 Palermo Dr
Riverside, CA 92507-2393

Mailing address

1622 Palermo Dr
Riverside, CA 92507-2393
Phone (951) 848-7441

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1640217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1922768431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1622 PALERMO DR",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925072393",
            "telephone_number": "951-848-7441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1622 PALERMO DR",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925072393",
            "telephone_number": "562-685-4610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGEL TIME CARE FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-23",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "CORNELL",
        "authorized_official_first_name": "JUAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "562-685-4610",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "177F00000X",
            "taxonomy_group": "",
            "desc": "Lodging",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; 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.