Healthcare Provider Details

I. General information

NPI: 1780671172
Provider Name (Legal Business Name): BRASWELLS COLONIAL CARE OF REDLANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 LAUREL AVE
REDLANDS CA
92373-4838
US

IV. Provider business mailing address

1618 LAUREL AVE
REDLANDS CA
92373-4838
US

V. Phone/Fax

Practice location:
  • Phone: 909-792-6050
  • Fax: 909-798-8341
Mailing address:
  • Phone: 909-792-6050
  • Fax: 909-798-8341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number240000307
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. JAMES H. BRASWELL
Title or Position: PRESIDENT
Credential:
Phone: 909-795-3821