Healthcare Provider Details

I. General information

NPI: 1740289982
Provider Name (Legal Business Name): ENSIGN WHITTIER WEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12385 EAST WASHINGTON BLVD
WHITTIER CA
90606-2502
US

IV. Provider business mailing address

12385 EAST WASHINGTON BLVD
WHITTIER CA
90606-2502
US

V. Phone/Fax

Practice location:
  • Phone: 562-693-7701
  • Fax: 562-693-6037
Mailing address:
  • Phone: 562-693-7701
  • Fax: 562-693-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000019
License Number StateCA

VIII. Authorized Official

Name: MS. SOON E BURNAM
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 949-540-1249