Organization
COVENANT LIVING WEST
Active
Other names
Mount Miguel Care Center, Mount Miguel Covenant Village Health Facility
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH MALZAHN (VICE PRESIDENT OF HEALTH SERVICES)
(773) 878-4430
Entity
Organization
Contact information
Practice address
325 KEMPTON ST, SPRING VALLEY, CA 91977-5810
(619) 479-4790
(619) 479-2337
Mailing address
325 KEMPTON ST, SPRING VALLEY, CA 91977-5810
(619) 479-4790
(619) 479-2337
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
090000080
CA
314000000X
Skilled Nursing Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC55134G
—
CA
Enumeration date
09/14/2006
Last updated
07/30/2019
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