Healthcare Provider Details

I. General information

NPI: 1902372360
Provider Name (Legal Business Name): SWEETWATER YV CHOLLA OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8515 CHOLLA AVE
YUCCA VALLEY CA
92284-4247
US

IV. Provider business mailing address

662 ENCINITAS BLVD STE 230
ENCINITAS CA
92024-6792
US

V. Phone/Fax

Practice location:
  • Phone: 760-365-0717
  • Fax:
Mailing address:
  • Phone: 760-652-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: AARON CHESLEY
Title or Position: OWNER
Credential:
Phone: 858-353-3849