# SAN GORGONIO MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003939711
- **Authorized official:** MR. JONATHAN BRENN (CEO)
- **Authorized official phone:** (951) 769-2100

## Contact information

- **Practice address:** 600 N HIGHLAND SPRINGS AVE, BANNING, CA 92220-3046
- **Practice address phone:** (951) 845-1121
- **Practice address fax:** (951) 469-0431
- **Mailing address:** 600 N HIGHLAND SPRINGS AVE, BANNING, CA 92220-3046
- **Mailing address phone:** (951) 845-1121
- **Mailing address fax:** (951) 469-0431

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | CA250001668 | CA | Yes |

## Other

- **Enumeration date:** 04/09/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 555722 | MEDICARE SNF PROVIDER NO | CA |
| 01 | — | LTC555722F | MEDICAID SNF PROVIDER NO | CA |