Healthcare Provider Details

I. General information

NPI: 1114901741
Provider Name (Legal Business Name): SOLHEIM LUTHERAN HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 MERTON AVE
LOS ANGELES CA
90041-1915
US

IV. Provider business mailing address

2236 MERTON AVE
LOS ANGELES CA
90041-1915
US

V. Phone/Fax

Practice location:
  • Phone: 323-257-7518
  • Fax: 323-255-3544
Mailing address:
  • Phone: 323-257-7518
  • Fax: 323-255-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberCA970000049
License Number StateCA

VIII. Authorized Official

Name: JAMES GRAUNKE
Title or Position: EXECUTIVE DIRECTOR
Credential: NHA
Phone: 323-257-7518