Braswells Ivy Retreat LTD
Organization Active NPI Skilled Nursing Facility · Mentone, CA
NPI 1750352191 · NPPES record last updated Jun 30, 2008
Key facts
- NPI
- 1750352191
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 240000158 (CA)
- Legal business name
- BRASWELLS IVY RETREAT LTD
- Practice address
- 2278 Nice Ave
Mentone, CA 92359-9655 - Phone
- (909) 794-1189
- Fax
- (909) 389-7449
- NPI assigned
- Feb 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Valerie Candelaria
- Title
- Director of Ar
- Phone
- (909) 446-8754
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 240000158 | CA | Yes |
Addresses
Primary practice location
2278 Nice Ave
Mentone, CA 92359-9655
Mailing address
2278 Nice Ave
Mentone, CA 92359-9655
Phone (909) 794-1189
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZT05985I | Medicaid | CA | |
| 555025 | Other | CA | MEDICARE PROVIDER NUMBER |
Other providers in Mentone, CA
- Arrowhead Senior Villas
- Bindiya Bajracharya
- Dejah Janae Benz
- Esther Bolanos
- Selah Aliyah Bourne
- Building a Generation
- Jackie Ann Burman-Solgan
- Rachel Cabuhat
- Yaritza Camacho
- Tina Marie Carrillo
All providers in Mentone, CA · Skilled Nursing Facility in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.