Provider Demographics
NPI:1114076601
Name:PILGRIM PLACE IN CLAREMONT
Entity Type:Organization
Organization Name:PILGRIM PLACE IN CLAREMONT
Other - Org Name:PILGRIM PLACE HEALTH SERVICES CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:VALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-399-5505
Mailing Address - Street 1:721 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4539
Mailing Address - Country:US
Mailing Address - Phone:909-399-5550
Mailing Address - Fax:909-399-5566
Practice Address - Street 1:721 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4539
Practice Address - Country:US
Practice Address - Phone:909-399-5550
Practice Address - Fax:909-399-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950000084313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT18542FMedicaid
05-5261Medicare ID - Type UnspecifiedMEDICARE
CA055261Medicare Oscar/Certification