Healthcare Provider Details

I. General information

NPI: 1841289923
Provider Name (Legal Business Name): GLENDALE ADVENTIST MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TER
GLENDALE CA
91206-4007
US

IV. Provider business mailing address

1509 WILSON TER
GLENDALE CA
91206-4007
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-8000
  • Fax: 818-546-5600
Mailing address:
  • Phone: 818-409-8000
  • Fax: 818-546-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number930000059
License Number StateCA

VIII. Authorized Official

Name: KEVIN ROBERTS
Title or Position: CEO/PRESIDENT
Credential:
Phone: 818-409-8289