=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033191374
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMBERCARE HEALTH CARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5125 MONTE VISTA ST
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90042-3931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-254-6125
-----------------------------------------------------
Fax | 323-254-0293
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5125 MONTE VISTA ST
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90042-3931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-254-6125
-----------------------------------------------------
Fax | 323-254-0293
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. LINDA K MONACO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-254-6125
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | LTC55165J
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 555165
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------