# GARDEN CREST CONVALESCENT HOSPITAL INC

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

## Provider details

- **NPI number:** 1861480097
- **Authorized official:** MR. PAUL H BARRON (ADMINISTRATOR)
- **Authorized official phone:** (323) 663-8281

## Contact information

- **Practice address:** 909 LUCILE AVE, LOS ANGELES, CA 90026-1511
- **Practice address phone:** (323) 663-8281
- **Practice address fax:** (323) 666-0095
- **Mailing address:** 909 LUCILE AVE, LOS ANGELES, CA 90026-1511
- **Mailing address phone:** (323) 663-8281
- **Mailing address fax:** (323) 666-0095

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 970000031 | CA | Yes |

## Other

- **Enumeration date:** 10/11/2005
- **Last updated:** 12/29/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0691270001 | CIGNA-DMERC | CA |
| 05 | — | LTC05161F | — | CA |