Basic Information
| Provider Information | |||||||||
| NPI: | 1821552712 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MESA VERDE CONVALESCENT HOSPITAL, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5900 WILSHIRE BLVD STE 1600 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900365016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233306572 | ||||||||
| FaxNumber: | 8666033566 | ||||||||
| Practice Location | |||||||||
| Address1: | 673 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926272708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495485585 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2019 | ||||||||
| LastUpdateDate: | 01/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | RECHNITZ | ||||||||
| AuthorizedOfficialFirstName: | SHLOMO | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6268001191 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.