Provider Demographics
NPI:1881681088
Name:SAN BERNARDINO CARE COMPANY
Entity Type:Organization
Organization Name:SAN BERNARDINO CARE COMPANY
Other - Org Name:MEDICAL CENTER CONVALESCENT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIENTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-884-4781
Mailing Address - Street 1:1937 PONTIUS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:467 E GILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5318
Practice Address - Country:US
Practice Address - Phone:909-884-4781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05149HMedicaid
CAZZT05149HMedicaid