MEDICARE: SFHCC 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

General Provider Information

NPI Number	:	1598480535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SFHCC LLC

Provider Business Mailing Address
First Line	:	4016 GRAND AVE STE A-1054
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-5491
Country	:	US
Telephone Number	:	626-523-8956
Fax Number	:	626-657-2778

Provider Business Practice Location Address
First Line	:	2309 N SANTA FE AVE
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90222-2824
Country	:	US
Telephone Number	:	310-639-8111
Fax Number	:	310-639-8114

Authorized Official
Title or Position	:	CO-MANAGER
Name	:	CAROLINE TAPANG DITULLIO
Credential	:
Telephone Number	:	626-523-8956

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	10/11/2022

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