Fillmore Convalescent Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FILLMORE CONVALESCENT CENTER, LLC

Practice address

118 B St
Fillmore, CA 93015-1763

Phone

(805) 524-0083

Fax

(805) 524-7260

NPI assigned

Oct 28, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Ananias Eduardo Gonzalez

Title

President/Ceo

Phone

(805) 524-0083

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912997016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 B ST",
            "city": "FILLMORE",
            "state": "CA",
            "postal_code": "930151763",
            "telephone_number": "805-524-0083",
            "fax_number": "805-524-7260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 B ST",
            "city": "FILLMORE",
            "state": "CA",
            "postal_code": "930151763",
            "telephone_number": "805-524-0083",
            "fax_number": "805-524-7260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FILLMORE CONVALESCENT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "ANANIAS",
        "authorized_official_middle_name": "EDUARDO",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "805-524-0083",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT18866H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Epiphany Care Homes Inc
• Epiphany Care Homes Inc
• Gene Wayne Evans, D.D.S.
• Giselle Fernandez, DDS
• Fillmore Area Transit Corp
• Fillmore Country Club
• Fillmore Unified School District
• Melissa Flores
• Kristen Rene Bustillos Fragoso, MSW
• Garfield Beach CVS LLC

• All providers in Fillmore, CA
• 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.