Organization
THC - ORANGE COUNTY LLC
Active
Other names
Kindred Hospital - San Gabriel Valley
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTA TRAYLOR (ADMINISTRATOR)
(502) 596-6063
Entity
Organization
Contact information
Practice address
845 N LARK ELLEN AVE, WEST COVINA, CA 91791
(626) 339-5451
(626) 967-3809
Mailing address
845 N LARK ELLEN AVE, WEST COVINA, CA 91791-1069
(626) 339-5451
(626) 967-3809
Taxonomy
Speciality
Code
Description
License number
State
282E00000X
Long Term Care Hospital
Primary
930000084
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
954494847
GREAT WEST
CA
01
—
954494848
TRICARE/CHAMPUS
CA
05
—
HSP32028F
—
CA
01
—
ZZZB1900Z
BLUE CROSS
CA
Enumeration date
10/26/2006
Last updated
09/15/2025
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