1174601280 NPI number — VERDUGO VALLEY CONVALESCENT HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174601280 NPI number — VERDUGO VALLEY CONVALESCENT HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERDUGO VALLEY CONVALESCENT HOSPITAL
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:
Provider Other Organization Name Type Code:
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:
1174601280
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9420 TOPANGA CANYON BLVD
Provider Second Line Business Mailing Address:
#207
Provider Business Mailing Address City Name:
CHATSWORTH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91311-5759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-882-7740
Provider Business Mailing Address Fax Number:
818-882-7764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9420 TOPANGA CANYON BLVD
Provider Second Line Business Practice Location Address:
#207
Provider Business Practice Location Address City Name:
CHATSWORTH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91311-5759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-882-7740
Provider Business Practice Location Address Fax Number:
818-882-7764
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KHATCHADURIAN
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
818-882-7740

Provider Taxonomy Codes

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

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

  • Identifier: ZZT05346H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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