Emmanuel Healthcare Center Pinecrest

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

EMMANUEL HEALTHCARE CENTER PINECREST

Practice address

6025 Pine Ave
Maywood, CA 90270-3108

Phone

(323) 560-0720

Fax

(323) 773-7872

NPI assigned

Nov 18, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Wenda L Dagenais, LIC ADMINISTRATOR

Title

Administrator

Phone

(323) 560-0720

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366424889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6025 PINE AVE",
            "city": "MAYWOOD",
            "state": "CA",
            "postal_code": "902703108",
            "telephone_number": "323-560-0720",
            "fax_number": "323-773-7872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6025 PINE AVE",
            "city": "MAYWOOD",
            "state": "CA",
            "postal_code": "902703108",
            "telephone_number": "323-560-0720",
            "fax_number": "323-773-7872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMMANUEL HEALTHCARE CENTER PINECREST",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAGENAIS",
        "authorized_official_first_name": "WENDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "323-560-0720",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LIC ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Maywood, CA
• Providers in Maywood, 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 Aug 22, 2020; 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.