Provider Demographics
NPI:1871582841
Name:EMBER HEALTH CARE CENTER GLENDALE
Entity type:Organization
Organization Name:EMBER HEALTH CARE CENTER GLENDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARCELONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-845-8507
Mailing Address - Street 1:201 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2803
Mailing Address - Country:US
Mailing Address - Phone:818-845-8507
Mailing Address - Fax:818-845-7910
Practice Address - Street 1:201 ALLEN AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-2803
Practice Address - Country:US
Practice Address - Phone:818-845-8507
Practice Address - Fax:818-845-7910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZT06111M314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06111MMedicaid
CAZZT06111MMedicaid