Healthcare Provider Details

I. General information

NPI: 1215296652
Provider Name (Legal Business Name): AVE MARIA CONVALESCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 JOSSELYN CANYON RD
MONTEREY CA
93940-5265
US

IV. Provider business mailing address

1249 JOSSELYN CANYON RD
MONTEREY CA
93940-5265
US

V. Phone/Fax

Practice location:
  • Phone: 831-373-1216
  • Fax: 831-242-8980
Mailing address:
  • Phone: 831-373-1216
  • Fax: 831-242-8980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070000009
License Number StateCA

VIII. Authorized Official

Name: JOHN W MILFORD
Title or Position: SNF ADMINISTRATOR
Credential: NHA
Phone: 831-373-1216