Healthcare Provider Details

I. General information

NPI: 1477389302
Provider Name (Legal Business Name): CATERED MANOR CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 N VIRGINIA RD
LONG BEACH CA
90807-2627
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 562-426-0394
  • Fax:
Mailing address:
  • Phone: 818-853-5760
  • 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: ABE BAK
Title or Position: MANAGER
Credential:
Phone: 818-853-5760