Provider Demographics
NPI:1154120533
Name:SPRING CANYON RCFE LLC
Entity type:Organization
Organization Name:SPRING CANYON RCFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:213-210-5773
Mailing Address - Street 1:18857 RAVENHURST WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-9413
Mailing Address - Country:US
Mailing Address - Phone:213-210-5773
Mailing Address - Fax:
Practice Address - Street 1:17061 SPRING CANYON PL
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-0235
Practice Address - Country:US
Practice Address - Phone:213-210-5773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility