Healthcare Provider Details

I. General information

NPI: 1114915121
Provider Name (Legal Business Name): SANDHURST CONVALESCENT GROUP, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13922 CERISE AVE
HAWTHORNE CA
90250-8688
US

IV. Provider business mailing address

13922 CERISE AVE
HAWTHORNE CA
90250-8688
US

V. Phone/Fax

Practice location:
  • Phone: 310-675-3304
  • Fax: 310-675-4389
Mailing address:
  • Phone: 310-675-3304
  • Fax: 310-675-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number910000107
License Number StateCA

VIII. Authorized Official

Name: ZACHARY RICHARDS
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-675-3304