Provider Demographics
NPI:1578690111
Name:CRAFTON HILLS COLLEGE
Entity Type:Organization
Organization Name:CRAFTON HILLS COLLEGE
Other - Org Name:HEALTH AND WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIACONA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-389-3272
Mailing Address - Street 1:11711 SAND CANYON RD
Mailing Address - Street 2:SSB 101
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-1742
Mailing Address - Country:US
Mailing Address - Phone:909-389-3272
Mailing Address - Fax:909-389-0772
Practice Address - Street 1:11711 SAND CANYON RD
Practice Address - Street 2:SSB 101
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-1742
Practice Address - Country:US
Practice Address - Phone:909-389-3272
Practice Address - Fax:909-389-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72154261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF12632Medicare UPIN