Healthcare Provider Details

I. General information

NPI: 1679562557
Provider Name (Legal Business Name): NOTELLAGE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4681 EAGLE ROCK BLVD
LOS ANGELES CA
90041
US

IV. Provider business mailing address

3050 SATURN STREET STE 201
BREA CA
92821
US

V. Phone/Fax

Practice location:
  • Phone: 323-257-8151
  • Fax: 323-257-2187
Mailing address:
  • Phone: 714-577-3880
  • Fax: 714-577-3895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000044
License Number StateCA

VIII. Authorized Official

Name: MRS. JEANNE NELSON
Title or Position: A/R MANAGER
Credential:
Phone: 714-577-3880