Healthcare Provider Details

I. General information

NPI: 1336959311
Provider Name (Legal Business Name): PASADENA PALACE TCU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 S FAIR OAKS AVE
PASADENA CA
91105-2618
US

IV. Provider business mailing address

6442 COLDWATER CANYON AVE STE 100
NORTH HOLLYWOOD CA
91606-1191
US

V. Phone/Fax

Practice location:
  • Phone: 626-737-0560
  • Fax:
Mailing address:
  • Phone: 818-853-5760
  • Fax:

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: CHONOCH GEWIRTZ
Title or Position: CFO
Credential:
Phone: 818-853-5760