MEDICARE: WILSHIRE HEALTHCARE CENTER LLC

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
1	314000000X	Skilled Nursing Facility	910000149	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437424215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSHIRE HEALTHCARE CENTER LLC

Provider Business Mailing Address
First Line	:	5120 W GOLDLEAF CIR STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-1297
Country	:	US
Telephone Number	:	323-596-2145
Fax Number	:	323-596-4645

Provider Business Practice Location Address
First Line	:	855 N FAIRFAX AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-7207
Country	:	US
Telephone Number	:	323-596-2145
Fax Number	:	323-596-4645

Authorized Official
Title or Position	:	CEO/CHAIRMAN
Name	:	STEPHEN REISSMAN
Credential	:
Telephone Number	:	310-574-3733

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	02/07/2013

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