Healthcare Provider Details

I. General information

NPI: 1932104213
Provider Name (Legal Business Name): BIXBY KNOLLS TOWERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3747 ATLANTIC AVE
LONG BEACH CA
90807-3428
US

IV. Provider business mailing address

3747 ATLANTIC AVE
LONG BEACH CA
90807-3428
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-6123
  • Fax: 562-426-1506
Mailing address:
  • Phone: 562-426-6123
  • Fax: 562-426-1506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000023
License Number StateCA

VIII. Authorized Official

Name: STUART HARTMAN
Title or Position: V.P. OF OPERATIONS
Credential:
Phone: 562-257-5100