Organization
BRASWELLS YUCAIPA VALLEY CONVALESCENT LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VALERIE CANDELARIA (DIRECTOR OF AR)
(909) 446-8754
Entity
Organization
Contact information
Practice address
35253 AVENUE H, YUCAIPA, CA 92399-5415
(909) 795-2476
(909) 795-0458
Mailing address
35253 AVENUE H, YUCAIPA, CA 92399-5415
(909) 795-2476
(909) 795-0458
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055557
MEDICARE PROVIDER NUMBER
CA
05
—
ZZT05557G
—
CA
Enumeration date
02/01/2006
Last updated
07/16/2007
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