# CASA BONITA CONVALESCENT HOSPITAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Casa Bonita Convalescent Hospital
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730269234
- **Authorized official:** IRA DAVID FRIEDMAN (MANAGER)
- **Authorized official phone:** (213) 389-6900

## Contact information

- **Practice address:** 535 E BONITA AVE, SAN DIMAS, CA 91773-3124
- **Practice address phone:** (909) 599-1248
- **Practice address fax:** (909) 599-7178
- **Mailing address:** 4032 WILSHIRE BLVD FL 6, LOS ANGELES, CA 90010-3425
- **Mailing address phone:** (213) 389-6900
- **Mailing address fax:** (909) 599-7178

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 950000095 | CA | Yes |

## Other

- **Enumeration date:** 10/17/2006
- **Last updated:** 09/29/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | LTC06291J | — | CA |
| 05 | — | LTC70110G | — | CA |