MEDICARE: SANTA FE 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	940000147	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	:	1225025836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA FE CONVALESCENT HOSPITAL INC

Provider Business Mailing Address
First Line	:	4115 E BROADWAY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-1532
Country	:	US
Telephone Number	:	562-930-0777
Fax Number	:	562-930-0728

Provider Business Practice Location Address
First Line	:	3294 SANTA FE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90810-2408
Country	:	US
Telephone Number	:	562-424-0757
Fax Number	:	562-988-8770

Authorized Official
Title or Position	:	CFO
Name	:	JULIE PHAM
Credential	:
Telephone Number	:	562-930-0777

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	02/18/2025

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