1154389872 NPI number — SANTA CLARITA CONVALESCENT

Table of content: (NPI 1154389872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154389872 NPI number — SANTA CLARITA CONVALESCENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANTA CLARITA CONVALESCENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SANTA CLARITA CONVALESCENT HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154389872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5600 SPRING MOUNTAIN RD
Provider Second Line Business Mailing Address:
103
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89146-8821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-893-8962
Provider Business Mailing Address Fax Number:
702-893-8961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23801 NEWHALL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-3126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-259-3660
Provider Business Practice Location Address Fax Number:
661-255-3709
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAVLOW
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-893-8962

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZT05728J , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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