Healthcare Provider Details

I. General information

NPI: 1750380390
Provider Name (Legal Business Name): DOWNEY COMMUNITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 TELEGRAPH RD
DOWNEY CA
90240-2425
US

IV. Provider business mailing address

9300 TELEGRAPH RD
DOWNEY CA
90240-2425
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-2567
  • Fax: 562-869-8788
Mailing address:
  • Phone: 562-869-2567
  • Fax: 562-869-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number94000135
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000135
License Number StateCA

VIII. Authorized Official

Name: MS. SOON E BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249