Healthcare Provider Details

I. General information

NPI: 1639178197
Provider Name (Legal Business Name): ALDERWOOD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BRIDGE ST
SAN GABRIEL CA
91775-2719
US

IV. Provider business mailing address

115 BRIDGE ST
SAN GABRIEL CA
91775-2719
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-4439
  • Fax: 626-289-0056
Mailing address:
  • Phone: 626-289-4439
  • Fax: 626-289-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number950000007
License Number StateCA

VIII. Authorized Official

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