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General NPI Number Information
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NPI Number | 1649271339
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Entity Type | Organization
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Legal Business Name | PLOTT NURSING HOME, LLC
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 800 E 5TH ST
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City | ONTARIO
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State | CA
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Zip | 91764-2432
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Country | US
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Telephone | 909-984-8629
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Fax | 909-984-1182
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Provider Business Mailing Address
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Address Line | 5455 WILSHIRE BLVD STE 1925
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City | LOS ANGELES
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State | CA
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Zip | 90036-4201
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Country | US
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Telephone | 323-655-6960
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Fax | 323-655-7122
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | ELIZABETH PLOTT TYLER
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Credential | J.D.
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Telephone | 323-655-6960
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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 |
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License Number State | CA
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