Healthcare Provider Details

I. General information

NPI: 1003012360
Provider Name (Legal Business Name): AMI/HTI TARZANA ENCINO JOINT VENTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16237 VENTURA BLVD
ENCINO CA
91436-2201
US

IV. Provider business mailing address

PO BOX 50585
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 818-881-0800
  • Fax:
Mailing address:
  • Phone: 626-300-4122
  • Fax: 818-907-8630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number930000051
License Number StateCA

VIII. Authorized Official

Name: MR. DOUGLAS E. RABE
Title or Position: VP OF TAXATION, TENET HEALTHCARE
Credential:
Phone: 469-893-2466