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General NPI Number Information
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NPI Number | 1790779288
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Entity Type | Organization
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Legal Business Name | AG REDLANDS, LLC
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 700 EAST HIGHLAND AVENUE
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City | REDLANDS
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State | CA
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Zip | 92374
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Country | US
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Telephone | 909-793-2678
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Fax | 909-307-9768
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Provider Business Mailing Address
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Address Line | 700 EAST HIGHLAND AVENUE
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City | REDLANDS
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State | CA
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Zip | 92374
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Country | US
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Telephone | 909-793-2678
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Fax | 310-574-1322
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JACOB WINTNER
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Credential |
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Telephone | 323-651-1808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 240000114
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License Number State | CA
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