MEDICARE: STUDIO CITY CONVALESCENT HOSPITAL 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	920000071	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	:	1821160839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STUDIO CITY CONVALESCENT HOSPITAL LLC

Provider Business Mailing Address
First Line	:	4032 WILSHIRE BLVD FL6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3425
Country	:	US
Telephone Number	:	213-389-6900
Fax Number	:	818-766-1618

Provider Business Practice Location Address
First Line	:	11429 VENTURA BLVD.
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3143
Country	:	US
Telephone Number	:	818-766-9551
Fax Number	:	818-766-1618

Authorized Official
Title or Position	:	MANAGER
Name	:	IRA DAVID FRIEDMAN
Credential	:
Telephone Number	:	213-389-6900

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	09/29/2023

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