# SAN PEDRO CONVALESCENT HOME, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LOS PALOS CONVALESCENT HOSPITAL
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306914775
- **Authorized official:** MRS. CELIA VALDOMAR NHA (ADMINISTRATOR)
- **Authorized official phone:** (310) 832-6431

## Contact information

- **Practice address:** 1430 W 6TH ST, SAN PEDRO, CA 90732-3503
- **Practice address phone:** (310) 832-6431
- **Practice address fax:** (310) 832-3390
- **Mailing address:** 1430 W 6TH ST, SAN PEDRO, CA 90732-3503
- **Mailing address phone:** (310) 832-6431
- **Mailing address fax:** (310) 832-3390

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | CA | Yes |

## Other

- **Enumeration date:** 12/01/2006
- **Last updated:** 03/06/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT05527F | — | CA |