Provider Demographics
NPI:1487750303
Name:MONTEREY PARK CONVALESCENT HOSPITAL INC
Entity type:Organization
Organization Name:MONTEREY PARK CONVALESCENT HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRESNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-577-3880
Mailing Address - Street 1:3050 SATURN STREET
Mailing Address - Street 2:SUITE #201
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6278
Mailing Address - Country:US
Mailing Address - Phone:714-577-3880
Mailing Address - Fax:714-577-3895
Practice Address - Street 1:416 GARFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754
Practice Address - Country:US
Practice Address - Phone:626-280-0280
Practice Address - Fax:626-280-9246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950000075314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05162GMedicaid
CAZZT05162GMedicaid
055162Medicare ID - Type Unspecified