Provider Demographics
NPI:1578633228
Name:TWO PALMS NURSING CENTER, INC.
Entity type:Organization
Organization Name:TWO PALMS NURSING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-798-8991
Mailing Address - Street 1:2637 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1412
Mailing Address - Country:US
Mailing Address - Phone:626-798-8991
Mailing Address - Fax:626-798-5086
Practice Address - Street 1:2637 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1412
Practice Address - Country:US
Practice Address - Phone:626-798-8991
Practice Address - Fax:626-798-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05464GMedicaid
CAZZT05464GMedicaid