Provider Demographics
NPI:1710707104
Name:SAINT PAUL CONGREGATE LIVING
Entity type:Organization
Organization Name:SAINT PAUL CONGREGATE LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ-LUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-445-7202
Mailing Address - Street 1:880 BAGHDADY ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-8264
Mailing Address - Country:US
Mailing Address - Phone:323-445-7202
Mailing Address - Fax:
Practice Address - Street 1:2721 TORY ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1947
Practice Address - Country:US
Practice Address - Phone:323-445-7202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility