G & C SWAN INC (NPI# 1659662351) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659662351 |
| Entity Type | Organization |
| Organization Name | G & C SWAN INC |
| Other Organization Name | HIS HOUSE |
| Practice Address |
239 W 9th St Upland CA 91786-5979 |
| Mailing Address |
1354 Carlos Pl Ontario CA 91764-2310 |
| Practice Telephone | 9099816121 |
| Practice Fax Number | 9099440192 |
| Mailing Telephone | 9099816121 |
| Mailing Fax Number | 9099440192 |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2020-02-12 |
| Authorized Official Name | MS. CAROL LYNN SWANSON (CFO) |
| Authorized Official Telephone | 9099816121 |
| Authorized Official Credential | BS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 360075BP | CA | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| His House | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174931794 | G & C Swan Inc | Substance Abuse Rehabilitation Facility | 563 N Central Ave, Upland, CA 91786-4241 | 2014-07-28 |
| 1649449554 | G & C Swan Inc | Substance Abuse Rehabilitation Facility | 120 W 9th St, T-3, Upland, CA 91786-5907 | 2008-02-25 |
| 1952885139 | G & C Swan Inc | Substance Abuse Rehabilitation Facility | 11646 Encanto Ln, Colton, CA 92324-9218 | 2018-09-24 |
| 1497132765 | G & C Swan Inc | Substance Abuse Rehabilitation Facility | 9491 Pittsburgh Ave, Rancho Cucamonga, CA 91730-9022 | 2015-05-06 |
| 1740569235 | G & C Swan Inc | Substance Abuse Rehabilitation Facility | 23950 Prado Ln, Colton, CA 92324-9734 | 2011-08-15 |
| Street Address |
239 W 9TH ST |
| City | UPLAND |
| State | CA |
| Zip Code | 91786-5979 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598366304 | Theresa Smith | Counselor | 239 W 9th St, Upland, CA 91786-5979 | 2020-11-06 |
| 1356941439 | Brianna Levy | Licensed Vocational Nurse | 239 W 9th St, Upland, CA 91786-5979 | 2020-10-28 |
| 1194349498 | Quintin Blaylock | Counselor | 239 W 9th St, Upland, CA 91786-5979 | 2020-06-02 |
| 1225651755 | John Morgan | Counselor | 239 W 9th St, Upland, CA 91786-5979 | 2020-05-19 |
| 1780217901 | James Lloyd Merkel | Counselor | 239 W 9th St, Upland, CA 91786-5979 | 2020-02-17 |
| 1336772870 | Andrew Freeman | Counselor | 239 W 9th St, Upland, CA 91786-5979 | 2020-02-12 |
| 1861025322 | Gerald Jeronimo Velarde | Counselor | 239 W 9th St, Upland, CA 91786-5979 | 2020-02-12 |
| 1437781093 | Krystal Rasmussen | Counselor | 239 W 9th St, Upland, CA 91786-5979 | 2020-02-11 |
| 1033741624 | Michael Thompson | Counselor | 239 W 9th St, Upland, CA 91786-5979 | 2020-02-11 |
| 1700418837 | Andrew Wildasinn | Counselor | 239 W 9th St, Upland, CA 91786-5979 | 2020-02-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366093254 | California Clinics, Inc | Physical Medicine & Rehabilitation | 818 N Mountain Ave Ste 102, Upland, CA 91786 | 2019-09-23 |
| 1699231621 | Lynn Keitz | Nurse Practitioner | 360 East 7th Street, Suite D, Upland, CA 91786 | 2019-02-14 |
| 1003386608 | Devin A Lockett | Counselor | 916 N, Mountain Ave. Suite D-1, Upland, CA 91786 | 2018-11-27 |
| 1265900096 | Right Ride | Driver | 1023 West Arrow Hwy Apt A, Upland, CA 91786 | 2018-11-09 |
| 1689142069 | Mike Sedat Safi | Driver | 1023 W Arrow Hwy, Apt A, Upland, CA 91786 | 2018-11-05 |
| 1902373640 | Barsoum Dental | Dentist | 258 E. 9th Street, Upland, CA 91786 | 2018-10-31 |
| 1346736600 | Jennifer Lynn Henshaw | Counselor | Rosewood Counseling Center, 288 W 9th Street, Upland, CA 91786 | 2018-07-10 |
| 1972099521 | Sadeg Aldolaim | Nurse Practitioner | 2086 W Arrow Route, Apt 824, Upland, CA 91786 | 2018-07-06 |
| 1831607332 | Sandra Sun | Pharmacist | 1445 E. Foothill Blvd., Upland, CA 91786 | 2018-01-18 |
| 1841713625 | Dynamic Performance Physical Therapy Inc | Clinic/Center | 2377 W. Foothill Blvd, Ste 20, Upland, CA 91786 | 2017-07-24 |
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| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174931794 | G & C Swan Inc | Substance Abuse Rehabilitation Facility | 563 N Central Ave, Upland, CA 91786-4241 | 2014-07-28 |
| 1649449554 | G & C Swan Inc | Substance Abuse Rehabilitation Facility | 120 W 9th St, T-3, Upland, CA 91786-5907 | 2008-02-25 |
| 1669800678 | Inland Valley Drug and Alcohol Recovery Services | Substance Abuse Rehabilitation Facility | 1260 E Arrow Hwy, Upland, CA 91786-4982 | 2013-10-30 |
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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.