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DSH050717 RANCHO LOS AMIGOS NATIONAL REHABILITATION CENTER (Active)
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Main Details
Name
RANCHO LOS AMIGOS NATIONAL REHABILITATION CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050717
Medicare Provider Number
050717
Additional Details
Current Program Status
Active
Registration Date
9/10/2007
Participating Start Date
1/1/2001
Participating Approval Date
9/10/2007
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Rancho Los Amigos National Rehabilitation Center
Konita Wilks, CEO
(562) 385-7022
Primary Contact
Rancho Los Amigos National Rehabilitation Center
Justin Phuc Phan, Pharmacist
(562) 385-8430
Addresses
Street Address
7601 IMPERIAL HIGHWAY
DOWNEY, CA 90242
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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