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MOUNTAINSIDE OPERATING COMPANY LLC NPI 1477547750


NPI Information

NPI: 1477547750
Provider Name: MOUNTAINSIDE OPERATING COMPANY, LLC

Doing Business As: COUNTRY VILLA HACIENDA HEALTHCARE CENTER

Classification: Skilled Nursing Facility - 314000000X
Entity Type: Organization
Address:
1311 E DATE ST
SAN BERNARDINO, CA
ZIP 92404
Phone: (909) 882-3316
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MOUNTAINSIDE OPERATING COMPANY, LLC is a skilled nursing facility in San Bernardino, CA. The provider is (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. MOUNTAINSIDE OPERATING COMPANY, LLC NPI is 1477547750. The provider is registered as an organization entity type.
The provider Is Doing Business As Country Villa Hacienda Healthcare Center.

The provider's business location address is:

1311 E DATE ST
SAN BERNARDINO, CA
ZIP 92404-233
Phone: (909) 882-3316
Fax: (909) 882-5126

The provider's authorized official is Stephen E. Reissman .
The authorized official title is Trustee Of Managing Member and has the following contact phone number (310) 574-3733.

The enumeration date for this NPI number is 9/1/2005 and was last updated on 2/4/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1314000000XSkilled Nursing Facility240000136CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1056053MEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA
2ZZT06053JMEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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