MEDICARE: VERNON CONVALESCENT HOSPITAL

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	:	1336184266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERNON CONVALESCENT HOSPITAL

Provider Business Mailing Address
First Line	:	1037 W VERNON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2415
Country	:	US
Telephone Number	:	323-232-4895
Fax Number	:	323-232-3096

Provider Business Practice Location Address
First Line	:	1037 W VERNON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2415
Country	:	US
Telephone Number	:	323-232-4895
Fax Number	:	323-232-3096

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. JACK MARKOVITZ
Credential	:
Telephone Number	:	562-761-7365

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	08/22/2020

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Directions to “VERNON CONVALESCENT HOSPITAL ” Practice Location

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