Healthcare Provider Details

I. General information

NPI: 1639257165
Provider Name (Legal Business Name): COLONIAL CARE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 E 5TH ST
LONG BEACH CA
90802-2024
US

IV. Provider business mailing address

4032 WILSHIRE BLVD FL 6
LOS ANGELES CA
90010-3425
US

V. Phone/Fax

Practice location:
  • Phone: 562-432-5751
  • Fax: 562-435-0361
Mailing address:
  • Phone: 213-389-6900
  • Fax: 213-368-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000043
License Number StateCA

VIII. Authorized Official

Name: DAVID FRIEDMAN
Title or Position: PRESIDENT
Credential:
Phone: 213-389-6900