Basic Information
| Provider Information | |||||||||
| NPI: | 1659627065 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EL SERENO MANOR, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SAN FERNANDO POST ACUTE HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13347 VENTURA BLVD | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914234267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183853200 | ||||||||
| FaxNumber: | 8183853275 | ||||||||
| Practice Location | |||||||||
| Address1: | 12260 FOOTHILL BLVD | ||||||||
| Address2: | |||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188999545 | ||||||||
| FaxNumber: | 8183853275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2012 | ||||||||
| LastUpdateDate: | 08/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | CHOHAN | ||||||||
| AuthorizedOfficialFirstName: | NASEER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 8183853235 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | ZZT18104H | 05 | CA | MEDICAID |