Provider Demographics
NPI:1366517393
Name:PRN CONVALESCENT HOSPITAL INC
Entity type:Organization
Organization Name:PRN CONVALESCENT HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-352-3158
Mailing Address - Street 1:7912 TOPLEY LN
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-3336
Mailing Address - Country:US
Mailing Address - Phone:818-352-3158
Mailing Address - Fax:818-352-2885
Practice Address - Street 1:7912 TOPLEY LN
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-3336
Practice Address - Country:US
Practice Address - Phone:818-352-3158
Practice Address - Fax:818-352-3718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA920000040314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05856HMedicaid
CA0726440001Medicare NSC
CAZZT05856HMedicaid