Healthcare Provider Details

I. General information

NPI: 1740736198
Provider Name (Legal Business Name): CORWIN KIDS HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18747 CORWIN RD
APPLE VALLEY CA
92307-2303
US

IV. Provider business mailing address

18747 CORWIN RD
APPLE VALLEY CA
92307-2303
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-5352
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: SHELLEY LOPEZ
Title or Position: PRESIDENT
Credential:
Phone: 760-242-5352