Healthcare Provider Details

I. General information

NPI: 1285079350
Provider Name (Legal Business Name): G&C SWAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1354 CARLOS PL
ONTARIO CA
91764-2310
US

IV. Provider business mailing address

333 E ARROW HWY #220
UPLAND CA
91785-7088
US

V. Phone/Fax

Practice location:
  • Phone: 909-241-7219
  • Fax: 909-985-2316
Mailing address:
  • Phone: 909-241-7219
  • Fax: 909-985-2316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number360075CP
License Number StateCA

VIII. Authorized Official

Name: MRS. GLENN SWANSON
Title or Position: CEO
Credential: CADAC II, BS, MBA
Phone: 909-241-7219