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General NPI Number Information
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NPI Number | 1053698134
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Entity Type | Organization
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Legal Business Name | CHARTER HEALTHCARE OF RANCHO CUCAMONGA, LLC
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 9229 UTICA AVE., SUITE 100
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4063
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Country | US
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Telephone | 866-669-1686
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Fax | 909-532-8685
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Provider Business Mailing Address
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Address Line | 9229 UTICA AVE., SUITE 100
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4063
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Country | US
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Telephone | 866-669-1686
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Fax | 909-532-8685
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Authorized Official
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Title or Position | ATTORNEY
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Name | SYLVIE BOAL
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Credential | ESQ
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Telephone | 866-669-1686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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