Organization
INDIAN CANYON PACC, LLC
Active
Other names
Indian Canyon Post Acute
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN R POWELL (PRESIDENT/MEMBER)
(909) 795-2421
Entity
Organization
Contact information
Practice address
57333 JOSHUA LN, YUCCA VALLEY, CA 92284-4124
(760) 853-4750
Mailing address
57333 JOSHUA LN, YUCCA VALLEY, CA 92284-4124
(951) 977-0777
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
07/29/2022
Last updated
02/16/2023
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