=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801616495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | G & C SWAN INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2024
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 638 S INDIAN HILL BLVD
-----------------------------------------------------
City | CLAREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91711-5444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-241-7219
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 E ARROW HWY UNIT 220
-----------------------------------------------------
City | UPLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91785-7008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-241-7219
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | CAROL SWANSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-476-2023
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------