Healthcare Provider Details

I. General information

NPI: 1750376554
Provider Name (Legal Business Name): UPLAND CONVALESCENT HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E ARROW HWY
UPLAND CA
91786-4911
US

IV. Provider business mailing address

1221 E ARROW HWY
UPLAND CA
91786-4911
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-1903
  • Fax: 909-985-4975
Mailing address:
  • Phone: 909-985-1903
  • Fax: 909-985-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES WILLIAM MILTON
Title or Position: PRESIDENT
Credential:
Phone: 909-985-1903