Healthcare Provider Details

I. General information

NPI: 1396744918
Provider Name (Legal Business Name): REDBROOK HEALTHCARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 TERRACINA BLVD
REDLANDS CA
92373-4845
US

IV. Provider business mailing address

105 TERRACINA BLVD
REDLANDS CA
92373-4845
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-2271
  • Fax: 909-792-6477
Mailing address:
  • Phone: 909-793-2271
  • Fax: 909-792-6477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number240000121
License Number StateCA

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249