Healthcare Provider Details

I. General information

NPI: 1861480097
Provider Name (Legal Business Name): GARDEN CREST CONVALESCENT HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 LUCILE AVE
LOS ANGELES CA
90026-1511
US

IV. Provider business mailing address

909 LUCILE AVE
LOS ANGELES CA
90026-1511
US

V. Phone/Fax

Practice location:
  • Phone: 323-663-8281
  • Fax: 323-666-0095
Mailing address:
  • Phone: 323-663-8281
  • Fax: 323-666-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000031
License Number StateCA

VIII. Authorized Official

Name: MR. PAUL H BARRON
Title or Position: ADMINISTRATOR
Credential:
Phone: 323-663-8281