Healthcare Provider Details

I. General information

NPI: 1831363548
Provider Name (Legal Business Name): EPISCOPAL COMMUNITIES & SERVICES FOR SENIORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 WEST CRESTRIDGE RD
RANCHO PALOS CA
90275
US

IV. Provider business mailing address

1111 S ARROYO PARKWAY STE 230
PASADENA CA
91105-3259
US

V. Phone/Fax

Practice location:
  • Phone: 310-541-2410
  • Fax: 626-281-2246
Mailing address:
  • Phone: 626-403-5880
  • Fax: 626-403-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number910000128
License Number StateCA

VIII. Authorized Official

Name: MRS. ELENA LIU
Title or Position: CONTROLLER
Credential:
Phone: 626-403-1482