Provider Demographics
NPI:1013726801
Name:HAMNER CONGREGATE CARE
Entity type:Organization
Organization Name:HAMNER CONGREGATE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:VANNOY
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:951-847-5476
Mailing Address - Street 1:7056 ARCHIBALD AVE STE 102-322
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-8713
Mailing Address - Country:US
Mailing Address - Phone:951-847-5476
Mailing Address - Fax:951-363-3200
Practice Address - Street 1:7121 MACKINAW CT
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752-1492
Practice Address - Country:US
Practice Address - Phone:951-847-5476
Practice Address - Fax:951-363-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility