=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760010607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 531 W. COLLEGE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2020
-----------------------------------------------------
Last Update Date | 03/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 531 W COLLEGE ST
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90012-2315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-229-9828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1668 S. GARFIELD AVE. 2ND FLOOR
-----------------------------------------------------
City | ALHAMBRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91801-5474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. PAUL J. HENSLER
-----------------------------------------------------
Credential | MSHA, FACHE
-----------------------------------------------------
Telephone | 626-328-3993
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------