Provider Demographics
NPI:1346251329
Name:CLARA BALDWIN STOCKER HOME FOR WOMEN
Entity Type:Organization
Organization Name:CLARA BALDWIN STOCKER HOME FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOECKRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-962-7151
Mailing Address - Street 1:527 S VALINDA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3008
Mailing Address - Country:US
Mailing Address - Phone:626-962-7151
Mailing Address - Fax:626-962-5007
Practice Address - Street 1:527 S VALINDA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3008
Practice Address - Country:US
Practice Address - Phone:626-962-7151
Practice Address - Fax:626-962-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2007-07-17
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
CA555832Medicare ID - Type Unspecified