Healthcare Provider Details

I. General information

NPI: 1346236106
Provider Name (Legal Business Name): BRETHREN HILLCREST HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 A ST
LA VERNE CA
91750-4303
US

IV. Provider business mailing address

2705 MOUNTAIN VIEW DR
LA VERNE CA
91750-4357
US

V. Phone/Fax

Practice location:
  • Phone: 909-392-4367
  • Fax: 909-392-4112
Mailing address:
  • Phone: 909-392-4917
  • Fax: 909-392-4112

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: MR. CHARLES E. CABLE
Title or Position: PRESIDENT AND C.E.O.
Credential:
Phone: 909-593-4917