Provider Demographics
NPI:1942936141
Name:JOSHUA TREE PACC, LLC
Entity Type:Organization
Organization Name:JOSHUA TREE PACC, LLC
Other - Org Name:JOSHUA TREE POST ACUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-795-2421
Mailing Address - Street 1:3281 E GUASTI RD STE 700
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8515 CHOLLA AVE
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-4247
Practice Address - Country:US
Practice Address - Phone:760-853-4760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility