Healthcare Provider Details

I. General information

NPI: 1588732499
Provider Name (Legal Business Name): SKYLIGHT CONVALESCENT HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WALNUT AVENUE
LONG BEACH CA
90813-3822
US

IV. Provider business mailing address

1201 WALNUT AVENUE
LONG BEACH CA
90813-3822
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-7621
  • Fax: 562-591-3292
Mailing address:
  • Phone: 562-591-7621
  • Fax: 562-591-3292

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. RENATO HILARIO FERRER
Title or Position: PRESIDENT
Credential:
Phone: 626-398-1702