Organization
LONE PINE HEALTH CARE LLC
Active
Other names
Valencia Palms
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFERY BLAINE HENDRICKSON (PRESIDENT)
(760) 347-0750
Entity
Organization
Contact information
Practice address
82262 VALENCIA AVE, INDIO, CA 92201-3120
(760) 347-6000
(760) 755-6828
Mailing address
PO BOX 10487, SAN BERNARDINO, CA 92423-0487
(909) 885-0268
(909) 884-1722
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05278J
—
CA
Enumeration date
09/07/2005
Last updated
08/22/2020
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