Healthcare Provider Details

I. General information

NPI: 1376963785
Provider Name (Legal Business Name): BEAUMONT MANOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N MICHIGAN AVE
BEAUMONT CA
92223-1728
US

IV. Provider business mailing address

4032 WILSHIRE BLVD FL 6
LOS ANGELES CA
90010-3425
US

V. Phone/Fax

Practice location:
  • Phone: 951-769-2500
  • Fax: 951-769-2511
Mailing address:
  • Phone: 213-389-6900
  • Fax: 213-368-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID FRIEDMAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 213-389-6900