Provider Demographics
NPI:1285079350
Name:G&C SWAN INC
Entity type:Organization
Organization Name:G&C SWAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:CADAC II, BS, MBA
Authorized Official - Phone:909-241-7219
Mailing Address - Street 1:333 E ARROW HWY
Mailing Address - Street 2:#220
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-7088
Mailing Address - Country:US
Mailing Address - Phone:909-241-7219
Mailing Address - Fax:909-985-2316
Practice Address - Street 1:1354 CARLOS PL
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-2310
Practice Address - Country:US
Practice Address - Phone:909-241-7219
Practice Address - Fax:909-985-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
323P00000X
CA360075CP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility