Organization
FILLMORE CONVALESCENT CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANANIAS EDUARDO GONZALEZ (PRESIDENT/CEO)
(805) 524-0083
Entity
Organization
Contact information
Practice address
118 B ST, FILLMORE, CA 93015-1763
(805) 524-0083
(805) 524-7260
Mailing address
118 B ST, FILLMORE, CA 93015-1763
(805) 524-0083
(805) 524-7260
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT18866H
—
CA
Enumeration date
10/28/2005
Last updated
08/22/2020
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