Country Villa Claremont Healthcare Center, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

950000053 Issued in CA

Legal business name

COUNTRY VILLA CLAREMONT HEALTHCARE CENTER, INC.

Doing business as

Country Villa Claremont Healthcare Center

Practice address

590 S Indian Hill Blvd
Claremont, CA 91711-5212

Phone

(909) 624-4511

Fax

(909) 624-4964

NPI assigned

Sep 7, 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

President

Phone

(310) 574-3733

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Country Villa Claremont Healthcare Center Doing business as

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390953600000",
    "number": "1982698882",
    "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": "590 S INDIAN HILL BLVD",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917115212",
            "telephone_number": "909-624-4511",
            "fax_number": "909-624-4964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY VILLA CLAREMONT HEALTHCARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-07",
        "last_updated": "2014-01-29",
        "status": "A",
        "authorized_official_last_name": "REISSMAN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-574-3733",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "950000053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05344J",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Villa Claremont Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Priscilla Contreras
• Robin Marie Cooper, PSY.D.
• Sandra Copenhaguen, L.C.S.W.
• Yvonne Cordero, LVN
• Andrea Cordova-Caddes, DPT
• Craig Godfrey Coy, DDS
• Norma Coyne, FNP
• Cronus Legacy. Inc
• Chris A Cruz, M.D.
• Maria G Cruz, RPT

• Skilled Nursing Facility in Claremont, CA
• Providers in Claremont, 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 Jan 29, 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.