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Organization
AG SAN GABRIEL, LLC
Active
Organization
AG SAN GABRIEL, LLC
Active
Other names
Broadway Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACOB WINTNER (MANAGER)
(323) 651-1808
Entity
Organization
Contact information
Practice address
112 EAST BROADWAY, SAN GABRIEL, CA 91776
(626) 285-2165
(626) 287-4061
Mailing address
112 EAST BROADWAY, SAN GABRIEL, CA 91776
(626) 285-2165
(310) 574-1322
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
950000016
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05592I
—
CA
Enumeration date
09/08/2005
Last updated
07/21/2014
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