Provider Demographics
NPI:1942385224
Name:SOUTHERN CALIFORNIA SPECIALTY CARE, LLC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA SPECIALTY CARE, LLC
Other - Org Name:KINDRED HOSPITAL - SAN GABRIEL VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-253-5121
Mailing Address - Street 1:845 N LARK ELLEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1069
Mailing Address - Country:US
Mailing Address - Phone:626-339-5451
Mailing Address - Fax:626-967-3809
Practice Address - Street 1:845 N LARK ELLEN AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791
Practice Address - Country:US
Practice Address - Phone:626-339-5451
Practice Address - Fax:626-967-3809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000084282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954494848OtherTRICARE/CHAMPUS
CAHSP32028FMedicaid
CAZZZB1900ZOtherBLUE CROSS
CAHSP32028FMedicaid
CA=========OtherGREAT WEST
CA=========OtherHUMANA
CA=========OtherKAISER PERMENENTE
CAZZZB1900ZOtherBLUE CROSS
CA=========OtherHEALTH NET
CA=========OtherAETNA
CA=========OtherCIGNA
CA=========OtherPACIFICARE
CA=========OtherGREAT WEST