Provider Demographics
NPI:1861018327
Name:COVINA CLHF CORPORATION
Entity Type:Organization
Organization Name:COVINA CLHF CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE MARIE
Authorized Official - Middle Name:ALICAYA
Authorized Official - Last Name:BRAGA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-377-3345
Mailing Address - Street 1:1411 S SANDIA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3309
Mailing Address - Country:US
Mailing Address - Phone:626-977-3345
Mailing Address - Fax:
Practice Address - Street 1:1411 S SANDIA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3309
Practice Address - Country:US
Practice Address - Phone:626-977-3345
Practice Address - Fax:626-977-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility