Provider Demographics
NPI:1891872644
Name:WINDSOR GARDENS CONVALESCENT HOSPITAL, INC
Entity Type:Organization
Organization Name:WINDSOR GARDENS CONVALESCENT HOSPITAL, INC
Other - Org Name:WINDSOR GARDENS CONVALESCENT HOSPITAL OF LOS ANGELES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-385-1090
Mailing Address - Street 1:915 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1938
Mailing Address - Country:US
Mailing Address - Phone:323-937-5466
Mailing Address - Fax:323-939-6753
Practice Address - Street 1:915 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1938
Practice Address - Country:US
Practice Address - Phone:323-937-5466
Practice Address - Fax:323-939-6753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
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
CAZZT06194LMedicaid
CA056194Medicare ID - Type Unspecified