Healthcare Provider Details

I. General information

NPI: 1346039179
Provider Name (Legal Business Name): HPA 1826 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W LEMON AVE
MONROVIA CA
91016-2809
US

IV. Provider business mailing address

107 W LEMON AVE
MONROVIA CA
91016-2809
US

V. Phone/Fax

Practice location:
  • Phone: 310-625-2838
  • Fax: 323-320-4355
Mailing address:
  • Phone: 310-625-2838
  • Fax: 323-320-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHERYL ANN PETTERSON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 310-625-2838