Healthcare Provider Details

I. General information

NPI: 1366424889
Provider Name (Legal Business Name): EMMANUEL HEALTHCARE CENTER PINECREST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 PINE AVE
MAYWOOD CA
90270-3108
US

IV. Provider business mailing address

6025 PINE AVE
MAYWOOD CA
90270-3108
US

V. Phone/Fax

Practice location:
  • Phone: 323-560-0720
  • Fax: 323-773-7872
Mailing address:
  • Phone: 323-560-0720
  • Fax: 323-773-7872

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: MRS. WENDA L DAGENAIS
Title or Position: ADMINISTRATOR
Credential: LIC ADMINISTRATOR
Phone: 323-560-0720