Healthcare Provider Details

I. General information

NPI: 1194120030
Provider Name (Legal Business Name): BLYTHE POST ACUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 W CHANSLOR WAY
BLYTHE CA
92225-1246
US

IV. Provider business mailing address

530 N PUENTE ST
BREA CA
92821-2804
US

V. Phone/Fax

Practice location:
  • Phone: 760-922-8176
  • Fax:
Mailing address:
  • Phone: 888-309-0022
  • Fax: 714-256-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID JOHNSON
Title or Position: CEO
Credential:
Phone: 888-309-0022