Healthcare Provider Details

I. General information

NPI: 1134175201
Provider Name (Legal Business Name): SANTA ANITA CONVALESCENT HOSPITAL & RETIREMENT CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5522 GRACEWOOD AVE
ARCADIA CA
91007-8409
US

IV. Provider business mailing address

5522 GRACEWOOD AVE
ARCADIA CA
91007-8409
US

V. Phone/Fax

Practice location:
  • Phone: 626-579-0310
  • Fax: 626-350-3005
Mailing address:
  • Phone: 626-579-0310
  • Fax: 626-350-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number950000093
License Number StateCA

VIII. Authorized Official

Name: MRS. MARY BELINDA JOHNSON
Title or Position: BOOKKEEPER
Credential:
Phone: 626-579-0310