Healthcare Provider Details

I. General information

NPI: 1275539454
Provider Name (Legal Business Name): MEK ARDEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 ALTA ARDEN EXPY
SACRAMENTO CA
95825-2103
US

IV. Provider business mailing address

1506 S. GLENDALE AVENUE
GLENDALE CA
91205
US

V. Phone/Fax

Practice location:
  • Phone: 916-481-5500
  • Fax: 916-481-9845
Mailing address:
  • Phone: 818-247-6200
  • Fax: 818-247-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100000009
License Number StateCA

VIII. Authorized Official

Name: MR. FERNAN PEDRAJA
Title or Position: FINANCIAL CONTROLLER
Credential:
Phone: 818-247-6200