BRASWELLS IVY RETREAT LTD (NPI# 1750352191) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750352191 |
| Entity Type | Organization |
| Organization Name | BRASWELLS IVY RETREAT LTD |
| Practice Address |
2278 Nice Ave Mentone CA 92359-9655 |
| Practice Telephone | 9097941189 |
| Practice Fax Number | 9093897449 |
| Mailing Telephone | 9097941189 |
| Mailing Fax Number | 9093897449 |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2008-06-30 |
| Authorized Official Name | MS. VALERIE CANDELARIA (DIRECTOR OF AR) |
| Authorized Official Telephone | 9094468754 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 240000158 | CA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDICARE PROVIDER NUMBER | 555025 | 01 |
| CA | ZZT05985I | 05 |
| Street Address |
2278 NICE AVE |
| City | MENTONE |
| State | CA |
| Zip Code | 92359-9655 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407243355 | Nice Avenue LLC | Skilled Nursing Facility | 2278 Nice Ave, Mentone, CA 92359-9655 | 2015-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275010852 | Pingkan Leilani Simauw | Case Manager/Care Coordinator | 10360 Rock St, Mentone, CA 92359 | 2018-07-25 |
| 1861676033 | Laurel Elizabeth Slater | Registered Nurse | 34346 Fishhatchery Rd, Mentone, CA 92359 | 2007-12-24 |
| 1356530786 | Lisa M Coonrod | Registered Nurse | 34452 Fish Hatchery Rd, Mentone, CA 92359-0122 | 2007-10-22 |
| 1841759768 | Christy Hart | Counselor | 1336 Wabash Ave, Mentone, CA 92359-1124 | 2019-03-19 |
| 1790923753 | Rose Garden Residential Care | Alzheimer Center (Dementia Center) | 1350 Wabash Ave, Mentone, CA 92359-1124 | 2009-01-29 |
| 1851639405 | Rose Garden Residential Operator, LLC | Assisted Living Facility | 1350 Wabash Ave, Mentone, CA 92359-1124 | 2013-01-16 |
| 1801150164 | Tania Marie Mccracken | Midwife | 1378 Turquoise Ave, Mentone, CA 92359-1257 | 2012-07-01 |
| 1033263298 | James Patrick Caley Dds | Dentist | 1856 Mentone Blvd Ste B, Mentone, CA 92359-1276 | 2007-01-23 |
| 1770803546 | Building A Generation | Early Intervention Provider Agency | 1320 Crafton Ave, Mentone, CA 92359-1318 | 2010-06-03 |
| 1710544713 | Elizabeth An Hess | Behavior Technician | 1365 Crafton Ave Apt 2092, Mentone, CA 92359-1354 | 2019-05-24 |
| Find all providers in zip 92359 | ||||
| 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 |
|---|---|---|---|---|
| 1407243355 | Nice Avenue LLC | Skilled Nursing Facility | 2278 Nice Ave, Mentone, CA 92359-9655 | 2015-04-17 |
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| 1043837966 | Desert Ridge Transitional Care Center, Lp | Skilled Nursing Facility | 13300 11th Avenue, Victorville, CA 92395 | 2020-06-26 |
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| 1780204024 | Neighbor Care Congregate Home, Inc. | Skilled Nursing Facility | 3249 Gerald Dr, Newbury Park, CA 91320-2948 | 2020-04-16 |
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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.