Healthcare Provider Details

I. General information

NPI: 1295781896
Provider Name (Legal Business Name): TEMPLE PARK CONVALESCENT HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 W TEMPLE ST
LOS ANGELES CA
90026-4817
US

IV. Provider business mailing address

2411 W TEMPLE ST
LOS ANGELES CA
90026-4817
US

V. Phone/Fax

Practice location:
  • Phone: 213-380-3210
  • Fax: 213-382-0595
Mailing address:
  • Phone: 213-380-3210
  • Fax: 213-382-0595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000074
License Number StateCA

VIII. Authorized Official

Name: VERONICA DY
Title or Position: MANAGER
Credential:
Phone: 213-487-3915