Healthcare Provider Details

I. General information

NPI: 1194898205
Provider Name (Legal Business Name): MID-WILSHIRE HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11210 LOWER AZUSA RD
EL MONTE CA
91731-1412
US

IV. Provider business mailing address

1101 CRENSHAW BLVD
LOS ANGELES CA
90019-3112
US

V. Phone/Fax

Practice location:
  • Phone: 626-442-6863
  • Fax: 626-350-3006
Mailing address:
  • Phone: 323-934-5660
  • Fax: 323-934-0852

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: MS. JOAN LEE
Title or Position: CEO/PRESIDENT
Credential:
Phone: 323-935-8490