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NPI Code Detail

MEDICARE: HILLCREST CONVALESCENT HOSPITAL INC

MEDICARE: HILLCREST 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
1314000000XSkilled Nursing FacilityZZT05364FCA

General Provider Information

NPI Number : 1174695175
Entity Type Code : Organization
Provider Name (Legal Business Name) : HILLCREST CONVALESCENT HOSPITAL INC
Provider Business Mailing Address
First Line : 3401 CEDAR AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-4422
Country : US
Telephone Number : 562-426-4461
Fax Number : 562-426-5731
Provider Business Practice Location Address
First Line : 3401 CEDAR AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-4422
Country : US
Telephone Number : 562-426-4461
Fax Number : 562-426-5731
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. BRAD O. DEHAAN
Credential :
Telephone Number : 562-426-4461
Provider Enumeration Date : 11/14/2006
Last Update Date : 11/07/2011

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