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General NPI Number Information
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NPI Number | 1821096066
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Entity Type | Organization
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Legal Business Name | MARY HEALTH OF THE SICK CONVALESCENT AND NURSING HOSPITAL INCORPORATED
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 2929 THERESA DR
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City | NEWBURY PARK
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State | CA
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Zip | 91320-3136
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Country | US
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Telephone | 805-498-3644
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Fax | 805-498-5112
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Provider Business Mailing Address
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Address Line | 2929 THERESA DR
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City | NEWBURY PARK
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State | CA
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Zip | 91320-3136
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Country | US
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Telephone | 805-498-3644
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Fax | 805-498-5112
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JODI RUPP
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Credential |
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Telephone | 805-498-3644
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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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