Provider Demographics
NPI:1477914679
Name:CHINO AVENUE CONGREGATE HOME INC
Entity Type:Organization
Organization Name:CHINO AVENUE CONGREGATE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-747-6546
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92822-0062
Mailing Address - Country:US
Mailing Address - Phone:714-747-6546
Mailing Address - Fax:909-635-6476
Practice Address - Street 1:3408 CHINO AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4714
Practice Address - Country:US
Practice Address - Phone:909-270-3293
Practice Address - Fax:909-635-6476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility