Provider Demographics
NPI:1952885139
Name:G & C SWAN INC
Entity Type:Organization
Organization Name:G & C SWAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-476-2023
Mailing Address - Street 1:333 E ARROW HWY UNIT 220
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-7008
Mailing Address - Country:US
Mailing Address - Phone:909-476-2023
Mailing Address - Fax:
Practice Address - Street 1:11646 ENCANTO LN
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-9218
Practice Address - Country:US
Practice Address - Phone:909-222-4079
Practice Address - Fax:909-697-2901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:G & C SWAN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-24
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility