=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063773075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN GABRIEL HEALTHCARE & WELLNESS CENTRE, LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2012
-----------------------------------------------------
Last Update Date | 10/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 BRIDGE ST
-----------------------------------------------------
City | SAN GABRIEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91775-2719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-289-4439
-----------------------------------------------------
Fax | 626-289-0056
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 BRIDGE ST
-----------------------------------------------------
City | SAN GABRIEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91775-2719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-289-4439
-----------------------------------------------------
Fax | 626-289-0056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | SHLOMO RECHNITZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-800-1191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 950000007
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------