Provider Demographics
NPI:1801891395
Name:DAVID ROSS INC.
Entity type:Organization
Organization Name:DAVID ROSS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLICER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-797-2120
Mailing Address - Street 1:1899 NORTH RAYMOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103
Mailing Address - Country:US
Mailing Address - Phone:626-797-2120
Mailing Address - Fax:626-797-2536
Practice Address - Street 1:1899 NORTH RAYMOND AVENUE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103
Practice Address - Country:US
Practice Address - Phone:626-797-2120
Practice Address - Fax:626-797-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA970000079314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC70166FMedicaid
CAZZT05862IMedicaid
CALTC70166FMedicaid