Healthcare Provider Details

I. General information

NPI: 1225090947
Provider Name (Legal Business Name): ELMCREST CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 SANTA ANITA AVENUE
EL MONTE CA
91733
US

IV. Provider business mailing address

3111 SANTA ANITA AVENUE
EL MONTE CA
91733
US

V. Phone/Fax

Practice location:
  • Phone: 626-443-0218
  • Fax: 626-443-4228
Mailing address:
  • Phone: 626-443-0218
  • Fax: 626-443-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number950000040
License Number StateCA

VIII. Authorized Official

Name: MICHAEL T. BERG
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 505-468-4752