Healthcare Provider Details

I. General information

NPI: 1013726801
Provider Name (Legal Business Name): HAMNER CONGREGATE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121 MACKINAW CT
EASTVALE CA
91752-1492
US

IV. Provider business mailing address

7056 ARCHIBALD AVE STE 102-322
EASTVALE CA
92880-8713
US

V. Phone/Fax

Practice location:
  • Phone: 951-847-5476
  • Fax: 951-363-3200
Mailing address:
  • Phone: 951-847-5476
  • Fax: 951-363-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LESLEY S VANNOY
Title or Position: CEO/OWNER
Credential: OWNER
Phone: 951-847-5476