Provider Demographics
NPI:1265445704
Name:THE HOME FOR THE AGES OF THE PROTESTANT EPISCOPAL CHURCH OF THE DIOCES
Entity Type:Organization
Organization Name:THE HOME FOR THE AGES OF THE PROTESTANT EPISCOPAL CHURCH OF THE DIOCES
Other - Org Name:CUMMINGS CARE CENTER AT THE KENSINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-300-6203
Mailing Address - Street 1:1111 S ARROYO PARKWAY
Mailing Address - Street 2:STE 230
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3259
Mailing Address - Country:US
Mailing Address - Phone:626-403-1482
Mailing Address - Fax:626-403-5880
Practice Address - Street 1:1428 SOUTH MARENGO AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-2348
Practice Address - Country:US
Practice Address - Phone:626-576-1032
Practice Address - Fax:626-403-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9500000553140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-5203Medicare ID - Type Unspecified