MEDICARE: CALIFORNIA CONVALESCENT HOSPITAL OF PASADENA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	9700000033	CA

General Provider Information

NPI Number	:	1437157567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA CONVALESCENT HOSPITAL OF PASADENA INC

Provider Business Mailing Address
First Line	:	120 BELLEFONTAINE ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3102
Country	:	US
Telephone Number	:	626-793-5114
Fax Number	:	626-793-7560

Provider Business Practice Location Address
First Line	:	120 BELLEFONTAINE ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3102
Country	:	US
Telephone Number	:	626-793-5114
Fax Number	:	626-793-7560

Authorized Official
Title or Position	:	CEO
Name	:	MR. BEN H GARRETT JR.
Credential	:
Telephone Number	:	626-282-8431

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	02/25/2014

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