# SAN GABRIEL VALLEY CONVALESCENT HOSPITAL, 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:** Penn Mar Therapeutic Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891781423
- **Authorized official:** DORI DIMLA (ADMINISTRATOR)
- **Authorized official phone:** (626) 401-1557

## Contact information

- **Practice address:** 3938 COGSWELL RD, EL MONTE, CA 91732-2404
- **Practice address phone:** (626) 401-1557
- **Mailing address:** 3938 COGSWELL RD, EL MONTE, CA 91732-2404
- **Mailing address phone:** (626) 401-1557

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 05A360 | CA | Yes |

## Other

- **Enumeration date:** 09/20/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | LTC 10040F | — | CA |