Provider Demographics
NPI:1407457450
Name:DELLBROOK GUEST HOME
Entity Type:Organization
Organization Name:DELLBROOK GUEST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANNOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-847-5476
Mailing Address - Street 1:13731 DELLBROOK ST
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-5521
Mailing Address - Country:US
Mailing Address - Phone:951-847-5476
Mailing Address - Fax:
Practice Address - Street 1:13731 DELLBROOK ST
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-5521
Practice Address - Country:US
Practice Address - Phone:951-847-5476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA336425136OtherCDSS