Healthcare Provider Details

I. General information

NPI: 1831476365
Provider Name (Legal Business Name): HAWTHORNE HEALTHCARE & WELLNESS CENTRE, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11630 GREVILLEA AVE
HAWTHORNE CA
90250-2231
US

IV. Provider business mailing address

11630 GREVILLEA AVE
HAWTHORNE CA
90250-2231
US

V. Phone/Fax

Practice location:
  • Phone: 310-679-9732
  • Fax: 310-679-3672
Mailing address:
  • Phone: 310-679-9732
  • Fax: 310-679-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number900000063
License Number StateCA

VIII. Authorized Official

Name: SHLOMO RECHNITZ
Title or Position: MANAGER
Credential:
Phone: 626-800-1191