MEDICARE: FERNVIEW CONVALESCENT HOSPITAL, 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

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	:	1891794939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERNVIEW CONVALESCENT HOSPITAL, INC

Provider Business Mailing Address
First Line	:	126 N SAN GABRIEL BLVD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91775-2427
Country	:	US
Telephone Number	:	626-285-3131
Fax Number	:	626-286-2391

Provider Business Practice Location Address
First Line	:	126 N SAN GABRIEL BLVD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91775-2427
Country	:	US
Telephone Number	:	626-285-3131
Fax Number	:	626-286-2391

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	03/27/2012

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