Provider Demographics
NPI:1144080201
Name:VENUS' COZY COTTAGE LLC
Entity type:Organization
Organization Name:VENUS' COZY COTTAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VENUS
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-508-6698
Mailing Address - Street 1:7172 EL PADRO ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2716
Mailing Address - Country:US
Mailing Address - Phone:562-508-6698
Mailing Address - Fax:
Practice Address - Street 1:2955 IRVINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-2005
Practice Address - Country:US
Practice Address - Phone:909-804-0082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility