Healthcare Provider Details

I. General information

NPI: 1619965837
Provider Name (Legal Business Name): BERKLEY VALLEY CONVALESCENT HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 SEPULVEDA BLVD
VAN NUYS CA
91411-1203
US

IV. Provider business mailing address

6600 SEPULVEDA BLVD
VAN NUYS CA
91411-1203
US

V. Phone/Fax

Practice location:
  • Phone: 818-786-0020
  • Fax: 818-786-5369
Mailing address:
  • Phone: 818-786-0020
  • Fax: 818-786-5369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number920000006
License Number StateCA

VIII. Authorized Official

Name: STEVEN GALPER
Title or Position: VICE PRESIDENT
Credential:
Phone: 310-829-5377