Healthcare Provider Details

I. General information

NPI: 1811390693
Provider Name (Legal Business Name): LONG BEACH POST ACUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WALNUT AVE
LONG BEACH CA
90813-3822
US

IV. Provider business mailing address

4115 E BROADWAY
LONG BEACH CA
90803-1532
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-7621
  • Fax: 562-591-3292
Mailing address:
  • Phone: 562-930-0777
  • Fax: 562-930-0777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number94000173
License Number StateCA

VIII. Authorized Official

Name: SIMCHA MANDELBAUM
Title or Position: MANAGER
Credential:
Phone: 562-930-0777