Healthcare Provider Details

I. General information

NPI: 1972506327
Provider Name (Legal Business Name): EL MONTE CONVALESCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4096 EASY ST.
EL MONTE CA
91731-1094
US

IV. Provider business mailing address

4096 EASY ST.
EL MONTE CA
91731-1094
US

V. Phone/Fax

Practice location:
  • Phone: 626-442-1500
  • Fax: 626-228-0193
Mailing address:
  • Phone: 626-442-1500
  • Fax: 626-228-0193

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. JESSE TELLES
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-442-1500