Provider Demographics
NPI:1467552406
Name:DOCTORS CONVALESCENT HOSPITAL
Entity Type:Organization
Organization Name:DOCTORS CONVALESCENT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGASPI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-693-5618
Mailing Address - Street 1:7926 PAINTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2413
Mailing Address - Country:US
Mailing Address - Phone:562-693-5618
Mailing Address - Fax:562-698-4816
Practice Address - Street 1:7926 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2413
Practice Address - Country:US
Practice Address - Phone:562-693-5618
Practice Address - Fax:562-698-4816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT18082GMedicaid
CAZZT18082GMedicaid