Healthcare Provider Details

I. General information

NPI: 1619979754
Provider Name (Legal Business Name): EISENHOWER NURSING & CONVALESCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 N FAIR OAKS AVE
PASADENA CA
91103-1801
US

IV. Provider business mailing address

1470 N FAIR OAKS AVE
PASADENA CA
91103-1801
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-9133
  • Fax: 626-798-7704
Mailing address:
  • Phone: 626-798-9133
  • Fax: 626-798-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID H BERGER
Title or Position: PRESIDENT
Credential:
Phone: 626-798-9133