Healthcare Provider Details

I. General information

NPI: 1033191374
Provider Name (Legal Business Name): EMBERCARE HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5125 MONTE VISTA ST
LOS ANGELES CA
90042-3931
US

IV. Provider business mailing address

5125 MONTE VISTA ST
LOS ANGELES CA
90042-3931
US

V. Phone/Fax

Practice location:
  • Phone: 323-254-6125
  • Fax: 323-254-0293
Mailing address:
  • Phone: 323-254-6125
  • Fax: 323-254-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberLTC55165J
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number555165
License Number StateCA

VIII. Authorized Official

Name: MS. LINDA K MONACO
Title or Position: ADMINISTRATOR
Credential:
Phone: 323-254-6125