Provider Demographics
NPI:1164534012
Name:LA SIERRA CONVALESCENT HOSPITAL, INC.
Entity Type:Organization
Organization Name:LA SIERRA CONVALESCENT HOSPITAL, INC.
Other - Org Name:LA SIERRA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-673-5149
Mailing Address - Street 1:632 E YOSEMITE AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-3343
Mailing Address - Country:US
Mailing Address - Phone:559-673-5149
Mailing Address - Fax:559-673-7249
Practice Address - Street 1:2424 M ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2808
Practice Address - Country:US
Practice Address - Phone:209-723-4224
Practice Address - Fax:209-723-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
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
CAZZR05271FMedicaid
CA05-5271Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER