MEDICARE: AMBERWOOD CONVALESCENT HOSPITAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124027677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBERWOOD CONVALESCENT HOSPITAL INC

Provider Business Mailing Address
First Line	:	6071 YORK BLVD
Second Line	:
City	:	HIGHLAND PARK
State	:	CA
Zip	:	90042-3503
Country	:	US
Telephone Number	:	323-254-3407
Fax Number	:	323-254-7580

Provider Business Practice Location Address
First Line	:	6071 YORK BLVD
Second Line	:
City	:	HIGHLAND PARK
State	:	CA
Zip	:	90042-3503
Country	:	US
Telephone Number	:	323-254-3407
Fax Number	:	323-254-7580

Authorized Official
Title or Position	:	CEO
Name	:	MR. BEN H GARRETT
Credential	:
Telephone Number	:	626-282-8431

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	08/22/2020

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