Healthcare Provider Details

I. General information

NPI: 1942306865
Provider Name (Legal Business Name): GIBRALTAR CONVALESCENT HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 NEVADA
EL MONTE CA
91733
US

IV. Provider business mailing address

3050 SATURN #201
BREA CA
92821-6278
US

V. Phone/Fax

Practice location:
  • Phone: 626-443-9425
  • Fax: 626-443-1624
Mailing address:
  • Phone: 714-577-3880
  • Fax: 714-577-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number950000099
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM C PRESNELL
Title or Position: CFO
Credential:
Phone: 714-577-3880