Provider Demographics
NPI:1629491972
Name:THE CALIFORNIA-PASADENA CONV HOSP
Entity Type:Organization
Organization Name:THE CALIFORNIA-PASADENA CONV HOSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-793-5114
Mailing Address - Street 1:120 BELLEFONTAINE ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3102
Mailing Address - Country:US
Mailing Address - Phone:626-793-5114
Mailing Address - Fax:
Practice Address - Street 1:120 BELLEFONTAINE ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3102
Practice Address - Country:US
Practice Address - Phone:626-793-5114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9700000033314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1437157567OtherMEDICARE NPI