Provider Demographics
NPI:1497132765
Name:G & C SWAN INC
Entity Type:Organization
Organization Name:G & C SWAN INC
Other - Org Name:NEW CREATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:CADAC II, BS, MBA
Authorized Official - Phone:909-243-7321
Mailing Address - Street 1:333 E ARROW HWY UNIT 220
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-7008
Mailing Address - Country:US
Mailing Address - Phone:909-476-2023
Mailing Address - Fax:
Practice Address - Street 1:3286 E GUASTI RD STE 100
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761
Practice Address - Country:US
Practice Address - Phone:909-476-2023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360075DP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility