Healthcare Provider Details

I. General information

NPI: 1508937343
Provider Name (Legal Business Name): VIRGIL SANITARIUM AND CONVALESCENT HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 N VIRGIL AVE
LOS ANGELES CA
90029-2944
US

IV. Provider business mailing address

975 N VIRGIL AVE
LOS ANGELES CA
90029-2944
US

V. Phone/Fax

Practice location:
  • Phone: 323-665-5793
  • Fax: 323-665-2683
Mailing address:
  • Phone: 323-665-5793
  • Fax: 323-665-2683

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: AVELINA RAMORAN
Title or Position: BOOKKEEPER
Credential:
Phone: 323-665-5793