Provider Demographics
NPI:1114998648
Name:CHANDLER CONVALESCENT HOSPITAL, INC
Entity Type:Organization
Organization Name:CHANDLER CONVALESCENT HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEUTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-985-1814
Mailing Address - Street 1:5335 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2711
Mailing Address - Country:US
Mailing Address - Phone:818-985-1814
Mailing Address - Fax:818-985-3128
Practice Address - Street 1:5335 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-2711
Practice Address - Country:US
Practice Address - Phone:818-985-1814
Practice Address - Fax:818-985-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-01-28
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
CA1290400001Medicare NSC
CA055932Medicare Oscar/Certification