Healthcare Provider Details

I. General information

NPI: 1114969540
Provider Name (Legal Business Name): KNOTT AVENUE CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9021 KNOTT AVE
BUENA PARK CA
90620-4138
US

IV. Provider business mailing address

3075 E THOUSAND OAKS BLVD
WESTLAKE VILLAGE CA
91362-3402
US

V. Phone/Fax

Practice location:
  • Phone: 714-826-2330
  • Fax: 714-527-6869
Mailing address:
  • Phone: 805-497-7330
  • Fax: 805-497-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELIZABETH J. CASEY
Title or Position: CFO
Credential:
Phone: 805-497-7330