Provider Demographics
NPI:1356849061
Name:SOUTH BAY SUNSET PAVILION
Entity Type:Organization
Organization Name:SOUTH BAY SUNSET PAVILION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RASMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGONG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-462-4942
Mailing Address - Street 1:1565 GULF AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2011
Mailing Address - Country:US
Mailing Address - Phone:310-729-5118
Mailing Address - Fax:
Practice Address - Street 1:1565 GULF AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-2011
Practice Address - Country:US
Practice Address - Phone:310-729-5118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility