Healthcare Provider Details

I. General information

NPI: 1568901809
Provider Name (Legal Business Name): BLUE JAY MANOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BLUE JAY LN
REDLANDS CA
92374-1650
US

IV. Provider business mailing address

35 BLUE JAY LN
REDLANDS CA
92374-1650
US

V. Phone/Fax

Practice location:
  • Phone: 818-281-5822
  • Fax: 909-335-2727
Mailing address:
  • Phone: 818-281-5822
  • Fax: 909-335-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number550003708
License Number StateCA

VIII. Authorized Official

Name: ELEANOR POSNER
Title or Position: DIRECTOR OF NURSING
Credential: REGISTERED NURSE
Phone: 818-281-5822