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NPI Code Detail

MEDICARE: BIXBY KNOLL PLACE

MEDICARE: BIXBY KNOLL PLACE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1315P00000XIntellectual Disabilities Intermediate Care FacilityCA

General Provider Information

NPI Number : 1427265800
Entity Type Code : Organization
Provider Name (Legal Business Name) : BIXBY KNOLL PLACE
Provider Business Mailing Address
First Line : 15920 S DALTON AVE
Second Line :
City : GARDENA
State : CA
Zip : 90247-3908
Country : US
Telephone Number : 310-808-0883
Fax Number : 310-808-0883
Provider Business Practice Location Address
First Line : 3706 PINE AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-3258
Country : US
Telephone Number : 562-595-9713
Fax Number : 562-595-0101
Authorized Official
Title or Position : LICENSEE
Name : SMYRNA DOJCINOVIC
Credential :
Telephone Number : 310-808-0883
Provider Enumeration Date : 05/16/2007
Last Update Date : 08/22/2020

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Directions to “BIXBY KNOLL PLACE ” Practice Location

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