Provider Demographics
NPI:1346236106
Name:BRETHREN HILLCREST HOMES
Entity Type:Organization
Organization Name:BRETHREN HILLCREST HOMES
Other - Org Name:WOODS HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:CABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-593-4917
Mailing Address - Street 1:2705 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-4357
Mailing Address - Country:US
Mailing Address - Phone:909-392-4917
Mailing Address - Fax:909-392-4112
Practice Address - Street 1:2600 A ST
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-4303
Practice Address - Country:US
Practice Address - Phone:909-392-4367
Practice Address - Fax:909-392-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06083FMedicaid
CAZZT06083FMedicaid