Healthcare Provider Details

I. General information

NPI: 1124027677
Provider Name (Legal Business Name): AMBERWOOD CONVALESCENT HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 YORK BLVD
HIGHLAND PARK CA
90042-3503
US

IV. Provider business mailing address

6071 YORK BLVD
HIGHLAND PARK CA
90042-3503
US

V. Phone/Fax

Practice location:
  • Phone: 323-254-3407
  • Fax: 323-254-7580
Mailing address:
  • Phone: 323-254-3407
  • Fax: 323-254-7580

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. BEN H GARRETT
Title or Position: CEO
Credential:
Phone: 626-282-8431