=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780671172
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRASWELLS COLONIAL CARE OF REDLANDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2005
-----------------------------------------------------
Last Update Date | 02/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1618 LAUREL AVE
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92373-4838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-792-6050
-----------------------------------------------------
Fax | 909-798-8341
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1618 LAUREL AVE
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92373-4838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-792-6050
-----------------------------------------------------
Fax | 909-798-8341
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JAMES H. BRASWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-795-3821
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 240000307
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------