Provider Demographics
NPI:1134505720
Name:SOUTH PASADENA CARE CENTER, LLC
Entity Type:Organization
Organization Name:SOUTH PASADENA CARE CENTER, LLC
Other - Org Name:SOUTH PASADENA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-380-9175
Mailing Address - Street 1:831 S LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4013
Mailing Address - Country:US
Mailing Address - Phone:213-380-9175
Mailing Address - Fax:
Practice Address - Street 1:904 MISSION ST
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3144
Practice Address - Country:US
Practice Address - Phone:626-399-0358
Practice Address - Fax:626-460-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA970000038OtherSKILLED NURSING FACILITY LICENSE