# BRASWELL'S COMMUNITY CONVALESCENT LTD

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

## Provider details

- **NPI number:** 1053382598
- **Authorized official:** MS. VALERIE CANDELARIA (DIRECTOR OF AR)
- **Authorized official phone:** (909) 446-8754

## Contact information

- **Practice address:** 13542 2ND ST, YUCAIPA, CA 92399-5396
- **Practice address phone:** (909) 795-2421
- **Practice address fax:** (909) 795-5939
- **Mailing address:** 13542 2ND ST, YUCAIPA, CA 92399-5396
- **Mailing address phone:** (909) 795-2421
- **Mailing address fax:** (909) 795-5939

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 240000236 | CA | Yes |

## Other

- **Enumeration date:** 02/01/2006
- **Last updated:** 06/06/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 056365 | MEDICARE PROVIDER NUMBER | CA |
| 05 | — | ZZT18152G | — | CA |