Healthcare Provider Details

I. General information

NPI: 1245897446
Provider Name (Legal Business Name): WEST COVINA CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 N SUNSET AVE
WEST COVINA CA
91790-1244
US

IV. Provider business mailing address

25910 ACERO STE 350
MISSION VIEJO CA
92691-7908
US

V. Phone/Fax

Practice location:
  • Phone: 626-962-4489
  • Fax: 626-869-0290
Mailing address:
  • Phone: 949-441-9258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARC JOHNSON
Title or Position: CFO
Credential:
Phone: 949-373-8373