MEDICARE: BLYTHE POST ACUTE LLC

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	:	1194120030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLYTHE POST ACUTE LLC

Provider Business Mailing Address
First Line	:	530 N PUENTE ST
Second Line	:
City	:	BREA
State	:	CA
Zip	:	92821-2804
Country	:	US
Telephone Number	:	888-309-0022
Fax Number	:	714-256-2003

Provider Business Practice Location Address
First Line	:	285 W CHANSLOR WAY
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-1246
Country	:	US
Telephone Number	:	760-922-8176
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAVID JOHNSON
Credential	:
Telephone Number	:	888-309-0022

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	12/30/2016

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Directions to “BLYTHE POST ACUTE LLC ” Practice Location

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