# COMMUNITY CONVALESCENT CENTER OF MONTCLAIR INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** COMMUNITY EXTENDED CARE HOSPITAL
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851388458
- **Authorized official:** MR. JOHN HENRY SY (VP OF REVENUE MANAGEMENT)
- **Authorized official phone:** (562) 930-0777

## Contact information

- **Practice address:** 9620 FREMONT AVE, MONTCLAIR, CA 91763-2320
- **Practice address phone:** (909) 621-4751
- **Practice address fax:** (909) 621-5410
- **Mailing address:** 4115 E BROADWAY, LONG BEACH, CA 90803-1532
- **Mailing address phone:** (562) 930-0777
- **Mailing address fax:** (562) 930-0728

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 240000243 | CA | Yes |

## Other

- **Enumeration date:** 09/29/2005
- **Last updated:** 05/28/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | LTC06444F | — | CA |
| 05 | — | LTC70142F | — | CA |