Healthcare Provider Details

I. General information

NPI: 1376516377
Provider Name (Legal Business Name): VILLA ELENA CONVALESCENT HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13226 STUDEBAKER RD
NORWALK CA
90650-2532
US

IV. Provider business mailing address

PO BOX 3000
LOMA LINDA CA
92354-9000
US

V. Phone/Fax

Practice location:
  • Phone: 562-868-0591
  • Fax: 562-929-2185
Mailing address:
  • Phone: 909-796-2595
  • Fax: 909-796-8797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000172
License Number StateCA

VIII. Authorized Official

Name: JAMES B. KILIAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 909-796-2595