Broadwater Ontario Care Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

240000181 Issued in CA

Legal business name

BROADWATER ONTARIO CARE CENTER, LLC

Doing business as

Ontario Healthcare Center

Practice address

1661 S Euclid Ave
Ontario, CA 91762-5826

Phone

(909) 984-6713

Fax

(909) 984-5254

NPI assigned

Feb 14, 2007

Last updated

Jun 9, 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

Douglas Easton

Title

Manager

Phone

(818) 368-1862

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ontario Healthcare Center Doing business as

Locations

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1316080260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1661 S EUCLID AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917625826",
            "telephone_number": "909-984-6713",
            "fax_number": "909-984-5254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 S EUCLID AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917625826",
            "telephone_number": "909-984-6713",
            "fax_number": "909-984-5254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWATER ONTARIO CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "EASTON",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "818-368-1862"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "240000181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316080260",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ontario Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Equllia Brown-Tucker

• Skilled Nursing Facility in Ontario, CA
• Providers in Ontario, 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 9, 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.