Braswell's Community Convalescent LTD

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

240000236 Issued in CA

Legal business name

BRASWELL'S COMMUNITY CONVALESCENT LTD

Practice address

13542 2ND St
Yucaipa, CA 92399-5396

Phone

(909) 795-2421

Fax

(909) 795-5939

NPI assigned

Feb 1, 2006

Last updated

Jun 6, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Valerie Candelaria

Title

Director of Ar

Phone

(909) 446-8754

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212710400000",
    "number": "1053382598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13542 2ND ST",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923995396",
            "telephone_number": "909-795-2421",
            "fax_number": "909-795-5939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13542 2ND ST",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923995396",
            "telephone_number": "909-795-2421",
            "fax_number": "909-795-5939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRASWELL'S COMMUNITY CONVALESCENT LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2008-06-06",
        "status": "A",
        "authorized_official_last_name": "CANDELARIA",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_title_or_position": "DIRECTOR OF AR",
        "authorized_official_telephone_number": "909-446-8754",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "240000236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "056365",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT18152G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teresa Nichelle Boyd
• Vernon R Bradley, LMFT
• Tonda Dale Bradshaw, DO
• Taylor Brand
• Jennifer Brasher, M.A., P.P.S.
• Braswell's Leisure Manor
• Braswell's Mediterranean Gardens, LP
• Braswells Hampton Manor LP
• Braswells Yucaipa Valley Convalescent LP
• Karina Yaretzi Bressant-Rocha

• Skilled Nursing Facility in Yucaipa, CA
• Providers in Yucaipa, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.