Healthcare Provider Details

I. General information

NPI: 1508862798
Provider Name (Legal Business Name): MEK LONG BEACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 E ESTHER ST
LONG BEACH CA
90804-2009
US

IV. Provider business mailing address

1506 S GLENDALE AVE
GLENDALE CA
91205-3316
US

V. Phone/Fax

Practice location:
  • Phone: 562-498-3368
  • Fax: 562-494-1786
Mailing address:
  • Phone: 818-247-6200
  • Fax: 818-247-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000065
License Number StateCA

VIII. Authorized Official

Name: MR. FERNAN PERDRAJA
Title or Position: FINANCIAL CONTROLLER
Credential:
Phone: 818-247-6200