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General NPI Number Information
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NPI Number | 1114076601
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Entity Type | Organization
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Legal Business Name | PILGRIM PLACE IN CLAREMONT
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 721 HARRISON AVE
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City | CLAREMONT
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State | CA
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Zip | 91711-4539
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Country | US
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Telephone | 909-399-5550
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Fax | 909-399-5566
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Provider Business Mailing Address
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Address Line | 721 HARRISON AVE
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City | CLAREMONT
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State | CA
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Zip | 91711-4539
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Country | US
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Telephone | 909-399-5550
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Fax | 909-399-5566
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | BERNARD M VALEK
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Credential |
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Telephone | 909-399-5505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 950000084
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License Number State | CA
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