Mission Lodge Sanitarium LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

MISSION LODGE SANITARIUM LLC

Practice address

824 S Gladys Ave
San Gabriel, CA 91776-2710

Phone

(626) 287-0753

NPI assigned

Oct 27, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Brian K. Reynolds

Title

Manager

Phone

(410) 513-8738

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433894400000",
    "number": "1184924953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1423 CLARKVIEW RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212092134",
            "telephone_number": "410-427-2700",
            "fax_number": "414-815-5558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 S GLADYS AVE",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917762710",
            "telephone_number": "626-287-0753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION LODGE SANITARIUM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-27",
        "last_updated": "2015-06-10",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "410-513-8738",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle KW Chen Medical Corporation
• Michelle L Chan a Professional Corporation
• Min Lwin DDS
• Pastor Alfredo Miranda
• Magid Bahaeldin Farpali Mirghani
• Kimberly Ann Mode, PTA
• Modern Moxa Needles LLC
• Valerie Molina Reyes
• Momentum Anesthesia Consultants Inc.
• Gary Yukio Moriguchi, D.D.S.

• Skilled Nursing Facility in San Gabriel, CA
• Providers in San Gabriel, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.