Provider Demographics
NPI:1417928862
Name:BRASWELL MEDICAL CONSULTANTS INC.
Entity Type:Organization
Organization Name:BRASWELL MEDICAL CONSULTANTS INC.
Other - Org Name:SKY HARBOR CARE CENTER, LP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:BRASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:909-795-3821
Mailing Address - Street 1:57333 JOSHUA LANE
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-4247
Mailing Address - Country:US
Mailing Address - Phone:760-365-4870
Mailing Address - Fax:760-369-1407
Practice Address - Street 1:57333 JOSHUA LANE
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284
Practice Address - Country:US
Practice Address - Phone:760-365-4870
Practice Address - Fax:760-369-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000320314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55773FMedicaid
CALTC55773FMedicaid