Healthcare Provider Details

I. General information

NPI: 1649262957
Provider Name (Legal Business Name): FOUNTAIN GARDENS CONVALESCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 SO SANTA ANA BLVD
LOS ANGELES CA
90059
US

IV. Provider business mailing address

2222 SO SANTA ANA BLVD
LOS ANGELES CA
90059
US

V. Phone/Fax

Practice location:
  • Phone: 323-564-4461
  • Fax: 323-569-9565
Mailing address:
  • Phone: 323-564-4461
  • Fax: 323-569-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JACK MARKOVITZ
Title or Position: OWNER
Credential:
Phone: 562-761-7365