Basic Information
| Provider Information | |||||||||
| NPI: | 1619965209 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | C & H HEALTH CARE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CENTINELA PARK CONVALESCENT HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 515 CENTINELA AVE | ||||||||
| Address2: | |||||||||
| City: | INGLEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 903023215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106744500 | ||||||||
| FaxNumber: | 3106749393 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 CENTINELA AVE | ||||||||
| Address2: | |||||||||
| City: | INGLEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 903023215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106744500 | ||||||||
| FaxNumber: | 3106749393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2005 | ||||||||
| LastUpdateDate: | 11/19/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CRUZ | ||||||||
| AuthorizedOfficialFirstName: | LYDIA | ||||||||
| AuthorizedOfficialMiddleName: | FLORO | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3239650600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | ZZT05608G | 05 | CA | MEDICAID |