Provider Demographics
NPI:1376524843
Name:HACIENDA CARE CENTER, INC.
Entity Type:Organization
Organization Name:HACIENDA CARE CENTER, INC.
Other - Org Name:SIERRA VALLEY REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-784-7375
Mailing Address - Street 1:301 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3429
Mailing Address - Country:US
Mailing Address - Phone:559-784-7375
Mailing Address - Fax:559-784-4636
Practice Address - Street 1:301 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3429
Practice Address - Country:US
Practice Address - Phone:559-784-7375
Practice Address - Fax:559-784-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000579314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05568HMedicaid
CAZZT05568HMedicaid