Basic Information
| Provider Information | |||||||||
| NPI: | 1942306865 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GIBRALTAR CONVALESCENT HOSPITAL INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SUNSET MANOR CONVALESCENT HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3050 SATURN | ||||||||
| Address2: | #201 | ||||||||
| City: | BREA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928216278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145773880 | ||||||||
| FaxNumber: | 7145773892 | ||||||||
| Practice Location | |||||||||
| Address1: | 2720 NEVADA | ||||||||
| Address2: | |||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264439425 | ||||||||
| FaxNumber: | 6264431624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 04/30/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PRESNELL | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7145773880 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 950000099 | CA | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.