Provider Demographics
NPI:1275539454
Name:MEK ARDEN, LLC
Entity Type:Organization
Organization Name:MEK ARDEN, LLC
Other - Org Name:ARDEN REHABILITATION AND HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDRAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-247-6200
Mailing Address - Street 1:1506 S. GLENDALE AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205
Mailing Address - Country:US
Mailing Address - Phone:818-247-6200
Mailing Address - Fax:818-247-6213
Practice Address - Street 1:3400 ALTA ARDEN EXPY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2103
Practice Address - Country:US
Practice Address - Phone:916-481-5500
Practice Address - Fax:916-481-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100000009314000000X
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05855JMedicaid
CA05D0704663OtherCLIA ID NUMBER
CA4279830001OtherDME POS NUMBER
CAZZR05855JMedicaid
CA4279830001Medicare NSC