Organization
AG SAN GABRIEL, LLC
Active
Other names
Broadway Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACOB WINTNER (MANAGER)
(323) 651-1808
Entity
Organization
Contact information
Practice address
112 EAST BROADWAY, SAN GABRIEL, CA 91776
(626) 285-2165
(626) 287-4061
Mailing address
112 EAST BROADWAY, SAN GABRIEL, CA 91776
(626) 285-2165
(310) 574-1322
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
950000016
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05592I
—
CA
Enumeration date
09/08/2005
Last updated
07/21/2014
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