Healthcare Provider Details

I. General information

NPI: 1790194769
Provider Name (Legal Business Name): GRAND AVENUE HEALTHCARE & WELLNESS CENTRE, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 GRAND AVE
LONG BEACH CA
90804-2011
US

IV. Provider business mailing address

3580 WILSHIRE BLVD STE 600
LOS ANGELES CA
90010-2502
US

V. Phone/Fax

Practice location:
  • Phone: 562-597-8817
  • Fax: 562-597-0230
Mailing address:
  • Phone: 323-330-6572
  • Fax: 866-603-3566

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: MR. SHLOMO RECHNITZ
Title or Position: MANAGING MEMBER
Credential:
Phone: 626-800-1191