Healthcare Provider Details

I. General information

NPI: 1942936141
Provider Name (Legal Business Name): JOSHUA TREE PACC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8515 CHOLLA AVE
YUCCA VALLEY CA
92284-4247
US

IV. Provider business mailing address

3281 E GUASTI RD STE 700
ONTARIO CA
91761-7643
US

V. Phone/Fax

Practice location:
  • Phone: 760-853-4760
  • Fax:
Mailing address:
  • Phone:
  • 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: STEVEN R POWELL
Title or Position: PRESIDENT/MEMBER
Credential:
Phone: 909-795-2421