Healthcare Provider Details

I. General information

NPI: 1447100748
Provider Name (Legal Business Name): PRIME HEALTHCARE SERVICES - SAN DIMAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 W COVINA BLVD
SAN DIMAS CA
91773-3245
US

IV. Provider business mailing address

1350 W COVINA BLVD
SAN DIMAS CA
91773-3245
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-6811
  • Fax:
Mailing address:
  • Phone: 909-599-6811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER DOAN
Title or Position: MANAGING ASSOCIATE GENERAL COUNSEL
Credential:
Phone: 310-259-4706