Provider Demographics
NPI:1215912910
Name:DEL AMO GARDENS CONVALESCENT
Entity type:Organization
Organization Name:DEL AMO GARDENS CONVALESCENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT SUP.
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:LINGAO
Authorized Official - Last Name:CARINGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-576-1284
Mailing Address - Street 1:22419 KENT AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2303
Mailing Address - Country:US
Mailing Address - Phone:310-378-4233
Mailing Address - Fax:310-378-1724
Practice Address - Street 1:22419 KENT AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2303
Practice Address - Country:US
Practice Address - Phone:310-378-4233
Practice Address - Fax:310-378-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910000039314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55706FMedicaid
CA555706Medicare Oscar/Certification
555706Medicare Oscar/Certification