Healthcare Provider Details

I. General information

NPI: 1114291523
Provider Name (Legal Business Name): 1100 SOUTH ALVARADO STREET, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 07/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S ALVARADO ST
LOS ANGELES CA
90006-4110
US

IV. Provider business mailing address

1100 S ALVARADO ST
LOS ANGELES CA
90006-4110
US

V. Phone/Fax

Practice location:
  • Phone: 213-487-3000
  • Fax: 213-487-1909
Mailing address:
  • Phone: 213-487-3000
  • Fax: 213-487-1909

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. MARTIN WEISS
Title or Position: MANAGER
Credential:
Phone: 818-385-3200