Healthcare Provider Details

I. General information

NPI: 1407499163
Provider Name (Legal Business Name): WEST GARDENA CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16530 S BROADWAY
GARDENA CA
90248-2714
US

IV. Provider business mailing address

6442 COLDWATER CANYON AVE STE 100
NORTH HOLLYWOOD CA
91606-1191
US

V. Phone/Fax

Practice location:
  • Phone: 917-842-8361
  • Fax:
Mailing address:
  • Phone: 310-329-9929
  • Fax:

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: CHONOCH GEWIRTZ
Title or Position: OWNER
Credential:
Phone: 310-329-9929