Healthcare Provider Details

I. General information

NPI: 1588770929
Provider Name (Legal Business Name): SELA HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 E 11TH ST
UPLAND CA
91786-4867
US

IV. Provider business mailing address

16742 ORANGE WAY
FONTANA CA
92335-3809
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-1981
  • Fax: 909-982-2885
Mailing address:
  • Phone: 909-987-7735
  • Fax: 909-484-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number240000203
License Number StateCA

VIII. Authorized Official

Name: MS. JENNIFER GREENWELL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 909-987-7735