Healthcare Provider Details

I. General information

NPI: 1316220247
Provider Name (Legal Business Name): CAMBRIDGE SIERRA HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 02/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 RECHE CANYON RD
COLTON CA
92324-9528
US

IV. Provider business mailing address

1350 RECHE CANYON RD
COLTON CA
92324-9528
US

V. Phone/Fax

Practice location:
  • Phone: 909-370-4411
  • Fax: 909-370-1846
Mailing address:
  • Phone: 909-370-4411
  • Fax: 909-370-1846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. LYNDA S. HEBBELN
Title or Position: CFO
Credential:
Phone: 727-723-3021