# MARY HEALTH OF THE SICK CONVALESCENT AND NURSING HOSPITAL INCORPORATED

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

## Provider details

- **NPI number:** 1821096066
- **Authorized official:** MRS. JODI RUPP (ADMINISTRATOR)
- **Authorized official phone:** (805) 498-3644

## Contact information

- **Practice address:** 2929 THERESA DR, NEWBURY PARK, CA 91320-3136
- **Practice address phone:** (805) 498-3644
- **Practice address fax:** (805) 498-5112
- **Mailing address:** 2929 THERESA DR, NEWBURY PARK, CA 91320-3136
- **Mailing address phone:** (805) 498-3644
- **Mailing address fax:** (805) 498-5112

## Taxonomy

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

## Other

- **Enumeration date:** 07/12/2005
- **Last updated:** 08/28/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT05022F | — | CA |