Provider Demographics
NPI:1124407903
Name:PRIME HEALTHCARE SERVICES - SAINT CLARE'S LLC
Entity Type:Organization
Organization Name:PRIME HEALTHCARE SERVICES - SAINT CLARE'S LLC
Other - Org Name:THE DWELLING PLACE AT SAINT CLARE'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-235-4300
Mailing Address - Street 1:3300 E GUASTI RD
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-8655
Mailing Address - Country:US
Mailing Address - Phone:909-235-4300
Mailing Address - Fax:909-235-4419
Practice Address - Street 1:400 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2525
Practice Address - Country:US
Practice Address - Phone:973-989-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility