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Organization
YUCAIPA VALLEY PEDIATRIC LIVING INC
Active
Organization
YUCAIPA VALLEY PEDIATRIC LIVING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HANAH J MALCOLM (LICENSEE)
(909) 499-0804
Entity
Organization
Contact information
Practice address
12193 CUSTER ST, YUCAIPA, CA 92399-4485
(909) 499-0804
Mailing address
12193 CUSTER ST, YUCAIPA, CA 92399-4485
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
06/11/2025
Last updated
06/11/2025
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