MEDICARE: ENSIGN SAN DIMAS LLC

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	950000090	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497755144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENSIGN SAN DIMAS LLC

Provider Business Mailing Address
First Line	:	1033 EAST ARROW HIGHWAY
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91740-6110
Country	:	US
Telephone Number	:	626-963-7531
Fax Number	:	626-914-7566

Provider Business Practice Location Address
First Line	:	1033 EAST ARROW HIGHWAY
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91740-6110
Country	:	US
Telephone Number	:	626-963-7531
Fax Number	:	626-914-7566

Authorized Official
Title or Position	:	AUTHORIZED AGENT OFFICER
Name	:	MS. SOON BURNAM
Credential	:
Telephone Number	:	949-540-1249

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	02/17/2021

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Directions to “ENSIGN SAN DIMAS LLC ” Practice Location

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