Provider Demographics
NPI:1467006163
Name:WEST VAN BUREN HEALTHCARE, INC.
Entity Type:Organization
Organization Name:WEST VAN BUREN HEALTHCARE, INC.
Other - Org Name:IRONDALE POST ACUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:7150 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-2261
Mailing Address - Country:US
Mailing Address - Phone:303-289-1770
Mailing Address - Fax:303-288-3517
Practice Address - Street 1:7150 POPLAR ST
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-2261
Practice Address - Country:US
Practice Address - Phone:303-289-1770
Practice Address - Fax:303-288-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility