Provider Demographics
NPI:1740489459
Name:SOUTH PASADENA CONVALESCENT INC.
Entity type:Organization
Organization Name:SOUTH PASADENA CONVALESCENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:REGGEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-799-9571
Mailing Address - Street 1:904 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:S PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3144
Mailing Address - Country:US
Mailing Address - Phone:626-799-9571
Mailing Address - Fax:
Practice Address - Street 1:904 MISSION ST
Practice Address - Street 2:
Practice Address - City:S PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3144
Practice Address - Country:US
Practice Address - Phone:626-799-9571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05931GMedicaid
CA055931Medicare Oscar/Certification