Provider Demographics
NPI:1104827898
Name:ORANGETREE CONVALESCENT HOSPITAL, LLC
Entity Type:Organization
Organization Name:ORANGETREE CONVALESCENT HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PLOTT TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:323-655-6960
Mailing Address - Street 1:5455 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1925
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4201
Mailing Address - Country:US
Mailing Address - Phone:323-655-6960
Mailing Address - Fax:323-655-7122
Practice Address - Street 1:4000 HARRISON ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3514
Practice Address - Country:US
Practice Address - Phone:951-785-6060
Practice Address - Fax:951-785-6710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000214314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT18680IMedicaid
CA555017Medicare Oscar/Certification
CA555017Medicare PIN