# MONTCLAIR MANOR CARE CENTER, LLC

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

## Provider details

- **NPI number:** 1689661357
- **Authorized official:** JENQ CHEN (OWNER)
- **Authorized official phone:** (310) 889-9929

## Contact information

- **Practice address:** 5119 BANDERA ST, MONTCLAIR, CA 91763-4410
- **Practice address phone:** (909) 626-1294
- **Mailing address:** 1937 PONTIUS AVE, LOS ANGELES, CA 90025-5611

## Taxonomy

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

## Other

- **Enumeration date:** 09/28/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT05718H | — | CA |