MEDICARE: EL MONTE 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	:	1972506327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL MONTE CONVALESCENT HOSPITAL

Provider Business Mailing Address
First Line	:	4096 EASY ST.
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-1094
Country	:	US
Telephone Number	:	626-442-1500
Fax Number	:	626-228-0193

Provider Business Practice Location Address
First Line	:	4096 EASY ST.
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-1094
Country	:	US
Telephone Number	:	626-442-1500
Fax Number	:	626-228-0193

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JESSE TELLES
Credential	:
Telephone Number	:	626-442-1500

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/30/2008

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Directions to “EL MONTE CONVALESCENT HOSPITAL ” Practice Location

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