Healthcare Provider Details

I. General information

NPI: 1588750202
Provider Name (Legal Business Name): MAGNOLIA GARDENS CONVALESCENT HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17922 SAN FERNANDO MISSION BLVD
GRANADA HILLS CA
91344-4043
US

IV. Provider business mailing address

4032 WILSHIRE BLVD FL6
LOS ANGELES CA
90010-3425
US

V. Phone/Fax

Practice location:
  • Phone: 818-360-1864
  • Fax: 818-360-3801
Mailing address:
  • Phone: 213-389-6900
  • Fax: 818-360-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number920000047
License Number StateCA

VIII. Authorized Official

Name: IRA DAVID FRIEDMAN
Title or Position: MANAGER
Credential:
Phone: 213-389-6900