Healthcare Provider Details

I. General information

NPI: 1811107410
Provider Name (Legal Business Name): GARDENA HOSPITAL, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 W REDONDO BEACH BLVD
GARDENA CA
90247-3511
US

IV. Provider business mailing address

222 N SEPULVEDA BLVD STE. 950
EL SEGUNDO CA
90245-5648
US

V. Phone/Fax

Practice location:
  • Phone: 310-532-4200
  • Fax:
Mailing address:
  • Phone: 310-356-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number930000098
License Number StateCA

VIII. Authorized Official

Name: MR. JAMES P MACPHERSON
Title or Position: OWNER
Credential:
Phone: 310-356-0550