Provider Demographics
NPI:1114915121
Name:SANDHURST CONVALESCENT GROUP, LTD.
Entity Type:Organization
Organization Name:SANDHURST CONVALESCENT GROUP, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-675-3304
Mailing Address - Street 1:13922 CERISE AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-8688
Mailing Address - Country:US
Mailing Address - Phone:310-675-3304
Mailing Address - Fax:310-675-4389
Practice Address - Street 1:13922 CERISE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-8688
Practice Address - Country:US
Practice Address - Phone:310-675-3304
Practice Address - Fax:310-675-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910000107314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06267IMedicaid
CAZZT06267IMedicaid