Provider Demographics
NPI:1093711681
Name:INLAND CHRISTIAN HOME, INC.
Entity Type:Organization
Organization Name:INLAND CHRISTIAN HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:STIENSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-983-0084
Mailing Address - Street 1:1950 S MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-6723
Mailing Address - Country:US
Mailing Address - Phone:909-983-0084
Mailing Address - Fax:909-983-0431
Practice Address - Street 1:1950 S MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6723
Practice Address - Country:US
Practice Address - Phone:909-983-0084
Practice Address - Fax:909-983-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000016314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT19208FMedicaid
CA555108Medicare Oscar/Certification
CA0387430001Medicare NSC