MEDICARE: SKYLIGHT CONVALESCENT HOSPITAL CORPORATION

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	:	1588732499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYLIGHT CONVALESCENT HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	1201 WALNUT AVENUE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3822
Country	:	US
Telephone Number	:	562-591-7621
Fax Number	:	562-591-3292

Provider Business Practice Location Address
First Line	:	1201 WALNUT AVENUE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3822
Country	:	US
Telephone Number	:	562-591-7621
Fax Number	:	562-591-3292

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RENATO HILARIO FERRER
Credential	:
Telephone Number	:	626-398-1702

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	02/25/2008

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Directions to “SKYLIGHT CONVALESCENT HOSPITAL CORPORATION ” Practice Location

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