MEDICARE: THE CALIFORNIA-PASADENA CONV HOSP

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	9700000033	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1437157567	OTHER	CA	MEDICARE NPI

General Provider Information

NPI Number	:	1629491972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CALIFORNIA-PASADENA CONV HOSP

Provider Business Mailing Address
First Line	:	120 BELLEFONTAINE ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3102
Country	:	US
Telephone Number	:	626-793-5114
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 BELLEFONTAINE ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3102
Country	:	US
Telephone Number	:	626-793-5114
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. BEN H GARRETT
Credential	:
Telephone Number	:	626-793-5114

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	01/22/2014

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Directions to “THE CALIFORNIA-PASADENA CONV HOSP ” Practice Location

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