Healthcare Provider Details

I. General information

NPI: 1215922570
Provider Name (Legal Business Name): UNITED CONVALESCENT FACILITIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 EAST ADAMS BOULEVARD
LOS ANGELES CA
90011
US

IV. Provider business mailing address

230 EAST ADAMS BOULEVARD
LOS ANGELES CA
90011
US

V. Phone/Fax

Practice location:
  • Phone: 213-748-0941
  • Fax: 213-748-3299
Mailing address:
  • Phone: 213-748-0941
  • Fax: 310-574-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000067
License Number StateCA

VIII. Authorized Official

Name: JACOB WINTNER
Title or Position: MANAGER
Credential:
Phone: 323-651-1808