Provider Demographics
NPI:1033294723
Name:SOUTHERN CALIFORNIA SPECIALTY CARE, LLC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA SPECIALTY CARE, LLC
Other - Org Name:KINDRED HOSPITAL - LA MIRADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-253-5121
Mailing Address - Street 1:14900 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2172
Mailing Address - Country:US
Mailing Address - Phone:562-944-1900
Mailing Address - Fax:562-906-3455
Practice Address - Street 1:14900 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638
Practice Address - Country:US
Practice Address - Phone:562-944-1900
Practice Address - Fax:562-906-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000084282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZB1919ZOtherBLUE CROSS
CAHSP32028FMedicaid
CA=========OtherAETNA
CA=========OtherPACIFICARE
CA=========OtherUNITED HEALTHCARE
CA=========OtherSECURE HORIZONS
CA=========OtherCIGNA
CA=========OtherHUMANA
CAHSP32028FMedicaid
CAHSP32028FMedicaid