Healthcare Provider Details

I. General information

NPI: 1821552712
Provider Name (Legal Business Name): MESA VERDE CONVALESCENT HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 CENTER ST
COSTA MESA CA
92627-2708
US

IV. Provider business mailing address

5900 WILSHIRE BLVD STE 1600
LOS ANGELES CA
90036-5016
US

V. Phone/Fax

Practice location:
  • Phone: 949-548-5585
  • Fax:
Mailing address:
  • Phone: 323-330-6572
  • Fax: 866-603-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: SHLOMO RECHNITZ
Title or Position: MANAGING MEMBER
Credential:
Phone: 626-800-1191