Provider Demographics
NPI:1699857193
Name:AB CRISPINO & CO. INC
Entity Type:Organization
Organization Name:AB CRISPINO & CO. INC
Other - Org Name:SANTA MONICA CONVALESCENT CENTER I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRISPINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-450-7694
Mailing Address - Street 1:2250 29TH STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2008
Mailing Address - Country:US
Mailing Address - Phone:310-450-7694
Mailing Address - Fax:310-450-8836
Practice Address - Street 1:2828 PICO BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1920
Practice Address - Country:US
Practice Address - Phone:310-450-7694
Practice Address - Fax:310-450-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
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
CALTC90076FMedicaid
CALTC90076FMedicaid