# BONNIE BRAE CONVALESCENT HOSPITAL INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487706628
- **Authorized official:** MISS ELMA B. CAYTON (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (213) 483-8144

## Contact information

- **Practice address:** 420 S BONNIE BRAE ST, LOS ANGELES, CA 90057-3010
- **Practice address phone:** (213) 483-8144
- **Practice address fax:** (213) 483-6145
- **Mailing address:** 420 S BONNIE BRAE ST, LOS ANGELES, CA 90057-3010
- **Mailing address phone:** (213) 483-8144
- **Mailing address fax:** (213) 483-1414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 970000062 | CA | Yes |

## Other

- **Enumeration date:** 01/17/2007
- **Last updated:** 11/21/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT05538G | — | CA |