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General NPI Number Information
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NPI Number | 1134175201
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Entity Type | Organization
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Legal Business Name | SANTA ANITA CONVALESCENT HOSPITAL & RETIREMENT CENTER, INC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 5522 GRACEWOOD AVE
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City | ARCADIA
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State | CA
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Zip | 91007-8409
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Country | US
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Telephone | 626-579-0310
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Fax | 626-350-3005
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Provider Business Mailing Address
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Address Line | 5522 GRACEWOOD AVE
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City | ARCADIA
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State | CA
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Zip | 91007-8409
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Country | US
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Telephone | 626-579-0310
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Fax | 626-350-3005
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Authorized Official
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Title or Position | BOOKKEEPER
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Name | MRS. MARY BELINDA JOHNSON
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Credential |
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Telephone | 626-579-0310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 950000093
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License Number State | CA
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