Provider Demographics
NPI:1508833666
Name:CHRISTIAN HERITAGE CARE CENTER
Entity Type:Organization
Organization Name:CHRISTIAN HERITAGE CARE CENTER
Other - Org Name:SUNSET HAVEN
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:V
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-949-4887
Mailing Address - Street 1:275 GARNET WAY
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5932
Mailing Address - Country:US
Mailing Address - Phone:909-949-4887
Mailing Address - Fax:909-949-8476
Practice Address - Street 1:275 GARNET WAY
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5932
Practice Address - Country:US
Practice Address - Phone:909-949-4887
Practice Address - Fax:909-949-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric