=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376516377
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLA ELENA CONVALESCENT HOSPITAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2006
-----------------------------------------------------
Last Update Date | 11/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13226 STUDEBAKER RD
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90650-2532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-868-0591
-----------------------------------------------------
Fax | 562-929-2185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3000
-----------------------------------------------------
City | LOMA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92354-9000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-796-2595
-----------------------------------------------------
Fax | 909-796-8797
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | JAMES B. KILIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-796-2595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 940000172
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------