SAN BERNARDINO CONVALESCENT OPERATIONS INC. (NPI# 1396739199) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396739199 |
| Entity Type | Organization |
| Organization Name | SAN BERNARDINO CONVALESCENT OPERATIONS INC. |
| Other Organization Name | LEGACY POST-ACUTE REHABILITATION CENTER |
| Practice Address |
1335 N Waterman Ave San Bernardino CA 92404-5312 |
| Mailing Address |
Po Box 10487 San Bernardino CA 92423-0487 |
| Practice Telephone | 9098850268 |
| Practice Fax Number | 9098885982 |
| Mailing Telephone | 9098850268 |
| Mailing Fax Number | 9098841722 |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2007-11-13 |
| Authorized Official Name | TRACEY A JOHNS (BUSINESS OFFICE MANAGER) |
| Authorized Official Telephone | 9098850268 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | CA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | ZZT05708H | 05 | |
| CA | LTC70122F | 05 |
| Other Name | Type Code |
|---|---|
| Legacy Post-Acute Rehabilitation Center | Doing Business As Name - Organization |
| Street Address |
1335 N WATERMAN AVE |
| City | SAN BERNARDINO |
| State | CA |
| Zip Code | 92404-5312 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174977292 | Julie Wood | Nurse Practitioner | 1335 N Waterman Ave, San Bernardino, CA 92404-5385 | 2016-04-14 |
| 1669850053 | Cynthia Youpele | Nurse Practitioner | 1335 N Waterman Ave, San Bernardino, CA 92404-5385 | 2015-05-18 |
| 1437482288 | Debra Lee Johnson | Physician Assistant | 1335 N Waterman Ave, San Bernardino, CA 92404-5385 | 2009-09-11 |
| 1669477337 | Demorgan Pasaribu | Registered Nurse | 1335 N Waterman Ave, San Bernardino, CA 92404-5312 | 2005-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740849363 | Danniella Alexandra Murillo | Physician Assistant | 2101 North Waterman Ave, San Bernardino, CA 92404 | 2019-06-07 |
| 1902377484 | Shauntel Renee Nelson | Student in an Organized Health Care Education/Training Program | 1481 N. Windsor Dr., San Bernardino, CA 92404 | 2018-12-10 |
| 1487123584 | Garrett M Grigg | Licensed Psychiatric Technician | 1481 N Windsor Dr, San Bernardino, CA 92404 | 2018-11-19 |
| 1881163434 | James Dean Anders | Counselor | 1481 Windsor Drive, San Bernardino, CA 92404 | 2018-11-13 |
| 1043703564 | Samantha Makpaiboonvatana | Optometrist | 1909 N Waterman Ave Ste 3, San Bernardino, CA 92404 | 2018-06-09 |
| 1861981623 | Christopher Windham | Behavior Technician | 2460 Fremontia Dr, San Bernardino, CA 92404 | 2018-05-08 |
| 1891145041 | Cynthia Lusy Gastelum | Marriage & Family Therapist | 1885 E Lynwood Dr Rm Se3, San Bernardino, CA 92404 | 2016-06-20 |
| 1336598259 | Foundation Enterprises LLC | Non-emergency Medical Transport (VAN) | 1663 Date Pl., #30390, San Bernardino, CA 92404 | 2016-06-10 |
| 1881042877 | Helen Ann Thompson | Speech-Language Pathologist | 1311 E. State St., San Bernardo, CA 92404 | 2016-05-31 |
| 1366839938 | Lanecia Richardson | Counselor | 135 Paul Drive, San Rafeal, CA 92404 | 2015-04-22 |
| Find all providers in zip 92404 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417904566 | Sunbridge Shandin Hills Rehabilition Center | Skilled Nursing Facility | 4164 N 4th Ave, San Bernardino, CA 92407-2908 | 2006-05-27 |
| 1851364855 | United Medical Management, Inc. | Skilled Nursing Facility | 1680 N Waterman Ave, San Bernardino, CA 92404-5113 | 2006-02-09 |
| 1447248075 | Arrowhead Home Convalescent Hospital | Skilled Nursing Facility | 4343 N Sierra Way, San Bernardino, CA 92407-3822 | 2005-10-07 |
| 1881681088 | San Bernardino Care Company | Skilled Nursing Facility | 467 E Gilbert St, San Bernardino, CA 92404-5318 | 2005-10-03 |
| 1477547750 | Mountainside Operating Company, LLC | Skilled Nursing Facility | 1311 E Date St, San Bernardino, CA 92404-4233 | 2005-09-01 |
| 1265433957 | Waterman Convalescent Hospital, LLC | Skilled Nursing Facility | 1850 N Waterman Ave, San Bernardino, CA 92404-4831 | 2005-08-03 |
| 1659768406 | Arrowhead Healthcare Center LLC | Skilled Nursing Facility | 4343 N Sierra Way, San Bernardino, CA 92407-3822 | 2015-04-20 |
| 1750789046 | Watermanidence Opco, LLC | Skilled Nursing Facility | 1850 N Waterman Ave, San Bernardino, CA 92404-4831 | 2014-12-18 |
| 1134527500 | Del Rosa Villaidence Opco, LLC | Skilled Nursing Facility | 2018 Del Rosa Ave, San Bernardino, CA 92404-5642 | 2014-12-16 |
| 1427457233 | Hacienda Heights Healthcare & Wellness Centre, Lp | Skilled Nursing Facility | 1311 E Date St, San Bernardino, CA 92404-4233 | 2014-08-18 |
| Find all providers in SAN BERNARDINO | ||||
| City | SAN BERNARDINO |
| Zip Code | 92404 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.