Provider Demographics
NPI:1003803842
Name:MENTAL HEALTH CONVALESCENT SERVICES, INC.
Entity Type:Organization
Organization Name:MENTAL HEALTH CONVALESCENT SERVICES, INC.
Other - Org Name:LAKEWOOD PARK HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ZILAFRO
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:562-869-0978
Mailing Address - Street 1:12023 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2635
Mailing Address - Country:US
Mailing Address - Phone:562-869-0978
Mailing Address - Fax:562-869-5376
Practice Address - Street 1:12023 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2635
Practice Address - Country:US
Practice Address - Phone:562-869-0978
Practice Address - Fax:562-869-5376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT18124HMedicaid
CAZZT18124HMedicaid