Provider Demographics
NPI:1871670117
Name:FOOTHILL NURSING COMPANY PARTNERSHIP
Entity Type:Organization
Organization Name:FOOTHILL NURSING COMPANY PARTNERSHIP
Other - Org Name:GLENDORA CANYON TRANSITIONAL CARE UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-853-5760
Mailing Address - Street 1:401 W ADA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4241
Mailing Address - Country:US
Mailing Address - Phone:626-335-9810
Mailing Address - Fax:626-963-0720
Practice Address - Street 1:401 W ADA AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4241
Practice Address - Country:US
Practice Address - Phone:626-335-9810
Practice Address - Fax:626-963-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950000120314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55416FMedicaid
CALTC55416FMedicaid