Healthcare Provider Details

I. General information

NPI: 1740684380
Provider Name (Legal Business Name): LA MIRADA HEALTCHARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11926 LA MIRADA BLVD
LA MIRADA CA
90638-1303
US

IV. Provider business mailing address

11440 VENTURA BLVD STE 200
STUDIO CITY CA
91604-3154
US

V. Phone/Fax

Practice location:
  • Phone: 562-943-7156
  • Fax:
Mailing address:
  • Phone:
  • 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: MICHAEL GASTWIRTH
Title or Position: OWNER
Credential:
Phone: 818-985-6600