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Organization
SAN GORGONIO MEMORIAL HOSPITAL
Active
Organization
SAN GORGONIO MEMORIAL HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN BRENN (CEO)
(951) 769-2100
Entity
Organization
Contact information
Practice address
600 N HIGHLAND SPRINGS AVE, BANNING, CA 92220-3046
(951) 845-1121
(951) 469-0431
Mailing address
600 N HIGHLAND SPRINGS AVE, BANNING, CA 92220-3046
(951) 845-1121
(951) 469-0431
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
CA250001668
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
555722
MEDICARE SNF PROVIDER NO
CA
01
—
LTC555722F
MEDICAID SNF PROVIDER NO
CA
Enumeration date
04/09/2007
Last updated
08/22/2020
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