Provider Demographics
NPI:1659627065
Name:EL SERENO MANOR, INC
Entity Type:Organization
Organization Name:EL SERENO MANOR, INC
Other - Org Name:SAN FERNANDO POST ACUTE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NASEER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-385-3235
Mailing Address - Street 1:13347 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-4267
Mailing Address - Country:US
Mailing Address - Phone:818-385-3200
Mailing Address - Fax:818-385-3275
Practice Address - Street 1:12260 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-899-9545
Practice Address - Fax:818-385-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT18104HMedicaid
CA555814Medicare Oscar/Certification