Provider Demographics
NPI:1457486110
Name:EITTOL, INC.
Entity Type:Organization
Organization Name:EITTOL, INC.
Other - Org Name:CHRISTOPHER HIGHLAND RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNELLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-335-3054
Mailing Address - Street 1:PO BOX 7680
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-0680
Mailing Address - Country:US
Mailing Address - Phone:909-335-3054
Mailing Address - Fax:909-335-9744
Practice Address - Street 1:1461 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-5421
Practice Address - Country:US
Practice Address - Phone:909-335-3054
Practice Address - Fax:909-335-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC61015FMedicaid