Provider Demographics
NPI:1275088916
Name:HYDE PARK REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:HYDE PARK REHABILITATION CENTER LLC
Other - Org Name:HYDE PARK HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLORZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-836-9397
Mailing Address - Street 1:107 W LEMON AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2809
Mailing Address - Country:US
Mailing Address - Phone:626-658-7344
Mailing Address - Fax:323-846-5788
Practice Address - Street 1:6520 WEST BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-4311
Practice Address - Country:US
Practice Address - Phone:323-753-1354
Practice Address - Fax:323-210-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910000066314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05326GMedicaid
CA056435Medicare Oscar/Certification