Organization
WATERMAN CONVALESCENT HOSPITAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH PLOTT TYLER J.D. (VICE PRESIDENT OF OPERATIONS)
(323) 655-6960
Entity
Organization
Contact information
Practice address
1850 N WATERMAN AVE, SAN BERNARDINO, CA 92404-4831
(909) 882-1215
(909) 881-2071
Mailing address
5455 WILSHIRE BLVD, STE 1925, LOS ANGELES, CA 90036-4201
(323) 655-6960
(323) 655-7122
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05565G
—
CA
Enumeration date
08/03/2005
Last updated
08/22/2020
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