Provider Demographics
NPI:1447525191
Name:TEMPLE CITY CONVALESCENT HOSPITAL CORPORATION
Entity type:Organization
Organization Name:TEMPLE CITY CONVALESCENT HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTOMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-397-6512
Mailing Address - Street 1:5101 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-3682
Mailing Address - Country:US
Mailing Address - Phone:626-443-3028
Mailing Address - Fax:626-443-1988
Practice Address - Street 1:5101 TYLER AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-3682
Practice Address - Country:US
Practice Address - Phone:626-443-3028
Practice Address - Fax:626-443-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility