Healthcare Provider Details

I. General information

NPI: 1851702286
Provider Name (Legal Business Name): MORNINGSIDE SPECIALTY HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 05/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 W MANCHESTER AVE SUITE 206K
LOS ANGELES CA
90047-3063
US

IV. Provider business mailing address

1704 W MANCHESTER AVE SUITE 206K
LOS ANGELES CA
90047-3063
US

V. Phone/Fax

Practice location:
  • Phone: 323-908-3265
  • Fax:
Mailing address:
  • Phone: 323-908-3265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. ZENON KESIK
Title or Position: PRESIDENT
Credential:
Phone: 323-908-3265