Healthcare Provider Details

I. General information

NPI: 1891420394
Provider Name (Legal Business Name): LA MIRADA POST ACUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 LA MIRADA BLVD
LA MIRADA CA
90638-1306
US

IV. Provider business mailing address

12200 LA MIRADA BLVD
LA MIRADA CA
90638-1306
US

V. Phone/Fax

Practice location:
  • Phone: 562-947-8691
  • Fax:
Mailing address:
  • Phone: 562-947-8691
  • 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: DAVID JOHNSON
Title or Position: CEO
Credential:
Phone: 714-577-3880