Provider Demographics
NPI:1780237214
Name:HAMILTON HOME
Entity type:Organization
Organization Name:HAMILTON HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIERSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPROUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-990-1748
Mailing Address - Street 1:940 STILLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3648
Mailing Address - Country:US
Mailing Address - Phone:909-801-7055
Mailing Address - Fax:909-748-8259
Practice Address - Street 1:940 STILLMAN AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3648
Practice Address - Country:US
Practice Address - Phone:909-801-7055
Practice Address - Fax:909-748-8259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility