Healthcare Provider Details

I. General information

NPI: 1073114807
Provider Name (Legal Business Name): THE HEALING SANCTUM-GREENMEADOW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5302 E GREENMEADOW RD
LONG BEACH CA
90808-1620
US

IV. Provider business mailing address

5302 E GREENMEADOW RD
LONG BEACH CA
90808-1620
US

V. Phone/Fax

Practice location:
  • Phone: 562-452-7893
  • Fax:
Mailing address:
  • Phone: 562-452-7893
  • 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: MINH NGUYEN
Title or Position: OWNER / FACILITY MEDICAL DIRECTOR
Credential: MD
Phone: 562-212-1272