Organization
MONTCLAIR MANOR CARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENQ CHEN (OWNER)
(310) 889-9929
Entity
Organization
Contact information
Practice address
5119 BANDERA ST, MONTCLAIR, CA 91763-4410
(909) 626-1294
Mailing address
1937 PONTIUS AVE, LOS ANGELES, CA 90025-5611
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05718H
—
CA
Enumeration date
09/28/2005
Last updated
08/22/2020
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