Healthcare Provider Details

I. General information

NPI: 1962510735
Provider Name (Legal Business Name): AYER LAR HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16530 S BROADWAY STREET
GARDENA CA
90248-2714
US

IV. Provider business mailing address

16530 S BROADWAY ST
GARDENA CA
90248-2714
US

V. Phone/Fax

Practice location:
  • Phone: 310-329-9929
  • Fax: 310-329-1024
Mailing address:
  • Phone: 310-889-9929
  • Fax: 310-889-9939

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: LEE AYERS
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-889-9929