Healthcare Provider Details

I. General information

NPI: 1093319022
Provider Name (Legal Business Name): MH CLAREMONT OPERATING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W SAN JOSE AVE
CLAREMONT CA
91711-5294
US

IV. Provider business mailing address

120 W SAN JOSE AVE
CLAREMONT CA
91711-5294
US

V. Phone/Fax

Practice location:
  • Phone: 909-447-5259
  • Fax: 909-447-5939
Mailing address:
  • Phone: 909-447-5259
  • Fax: 909-447-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. HENRY JAMES VAUGHN
Title or Position: REIMBURSEMENT ANALYST
Credential:
Phone: 240-595-6025