Healthcare Provider Details

I. General information

NPI: 1154389872
Provider Name (Legal Business Name): SANTA CLARITA CONVALESCENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23801 NEWHALL AVE
NEWHALL CA
91321-3126
US

IV. Provider business mailing address

5600 SPRING MOUNTAIN RD 103
LAS VEGAS NV
89146-8821
US

V. Phone/Fax

Practice location:
  • Phone: 661-259-3660
  • Fax: 661-255-3709
Mailing address:
  • Phone: 702-893-8962
  • Fax: 702-893-8961

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: STEVEN R. PAVLOW
Title or Position: PRESIDENT
Credential:
Phone: 702-893-8962