Provider Demographics
NPI:1336137835
Name:ROYAL OAKS CONVALESCENT HOSPITAL
Entity Type:Organization
Organization Name:ROYAL OAKS CONVALESCENT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:FLORO
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-965-0600
Mailing Address - Street 1:250 N VERDUGO RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3930
Mailing Address - Country:US
Mailing Address - Phone:818-244-1133
Mailing Address - Fax:818-246-1149
Practice Address - Street 1:250 N VERDUGO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-3930
Practice Address - Country:US
Practice Address - Phone:818-244-1133
Practice Address - Fax:818-246-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05523IMedicaid
CA055523Medicare ID - Type Unspecified