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General NPI Number Information
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NPI Number | 1770689697
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Entity Type | Organization
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Legal Business Name | WYNGATE NURSING CENTER
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 7660 WYNGATE ST
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City | TUJUNGA
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State | CA
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Zip | 91042-1736
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Country | US
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Telephone | 818-352-1454
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Fax | 818-951-4250
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Provider Business Mailing Address
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Address Line | 3050 SATURN STREET SUITE #201
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City | BREA
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State | CA
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Zip | 92821-6278
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Country | US
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Telephone | 714-577-3880
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Fax | 714-577-3895
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Authorized Official
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Title or Position | SR VP FINANCE
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Name | MR. MARK A MORTENSEN
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Credential |
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Telephone | 714-577-3880
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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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