MEDICARE: P & M HEALTHCARE HOLDINGS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	2400000105	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366558827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P & M HEALTHCARE HOLDINGS INC

Provider Business Mailing Address
First Line	:	16742 ORANGE WAY
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92335-3809
Country	:	US
Telephone Number	:	909-987-7735
Fax Number	:	909-484-6809

Provider Business Practice Location Address
First Line	:	9333 LA MESA DR
Second Line	:
City	:	ALTA LOMA
State	:	CA
Zip	:	91701-5805
Country	:	US
Telephone Number	:	909-987-2501
Fax Number	:	909-987-0282

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MS. JENNIFER GREENWELL
Credential	:
Telephone Number	:	909-987-7735

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/19/2015

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