Organization
WICORO INC
Active
Other names
Colonial Manor Conv Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN MORALES (OFFICE MANAGER)
(909) 373-3766
Entity
Organization
Contact information
Practice address
919 N SUNSET AVE, WEST COVINA, CA 91790-1244
(626) 962-4489
(626) 337-4044
Mailing address
919 N SUNSET AVE, WEST COVINA, CA 91790-1244
(626) 962-4489
(626) 337-4044
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
950000025
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT18368I
—
CA
Enumeration date
11/09/2006
Last updated
01/21/2010
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