Braswells Ivy Retreat LTD

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

240000158 Issued in 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

Last updated

Jun 30, 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

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1750352191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2278 NICE AVE",
            "city": "MENTONE",
            "state": "CA",
            "postal_code": "923599655",
            "telephone_number": "909-794-1189",
            "fax_number": "909-389-7449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2278 NICE AVE",
            "city": "MENTONE",
            "state": "CA",
            "postal_code": "923599655",
            "telephone_number": "909-794-1189",
            "fax_number": "909-389-7449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRASWELLS IVY RETREAT LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2008-06-30",
        "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": "240000158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Mentone, CA
• Providers in Mentone, 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 30, 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.