Healthcare Provider Details

I. General information

NPI: 1437157567
Provider Name (Legal Business Name): CALIFORNIA CONVALESCENT HOSPITAL OF PASADENA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BELLEFONTAINE ST
PASADENA CA
91105-3102
US

IV. Provider business mailing address

120 BELLEFONTAINE ST
PASADENA CA
91105-3102
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-5114
  • Fax: 626-793-7560
Mailing address:
  • Phone: 626-793-5114
  • Fax: 626-793-7560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number9700000033
License Number StateCA

VIII. Authorized Official

Name: MR. BEN H GARRETT JR.
Title or Position: CEO
Credential:
Phone: 626-282-8431