Basic Information
| Provider Information | |||||||||
| NPI: | 1659445203 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PHILMAR CARE LLC | ||||||||
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| OtherOrganizationName: | SAN FERNANDO POST ACUTE HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16742 ORANGE WAY | ||||||||
| Address2: | |||||||||
| City: | FONTANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923353809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099877735 | ||||||||
| FaxNumber: | 9094846809 | ||||||||
| Practice Location | |||||||||
| Address1: | 12260 FOOTHILL BLVD | ||||||||
| Address2: | |||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913426001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188999545 | ||||||||
| FaxNumber: | 8188902142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 08/19/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GREENWELL | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9099877735 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 920000031 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | LTC55814F | 05 | CA | MEDICAID | LTC70160F | 05 | CA | MEDICAID |