Healthcare Provider Details

I. General information

NPI: 1366558827
Provider Name (Legal Business Name): P & M HEALTHCARE HOLDINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 LA MESA DR
ALTA LOMA CA
91701-5805
US

IV. Provider business mailing address

16742 ORANGE WAY
FONTANA CA
92335-3809
US

V. Phone/Fax

Practice location:
  • Phone: 909-987-2501
  • Fax: 909-987-0282
Mailing address:
  • Phone: 909-987-7735
  • Fax: 909-484-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2400000105
License Number StateCA

VIII. Authorized Official

Name: MS. JENNIFER GREENWELL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 909-987-7735