Healthcare Provider Details

I. General information

NPI: 1134156698
Provider Name (Legal Business Name): NORTH STAR HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 FOUNTAIN AVE
LOS ANGELES CA
90029-1006
US

IV. Provider business mailing address

5401 FOUNTAIN AVE
LOS ANGELES CA
90029-1006
US

V. Phone/Fax

Practice location:
  • Phone: 323-465-2106
  • Fax: 323-465-3703
Mailing address:
  • Phone: 323-465-2106
  • Fax:

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: SHEILAH GRIER
Title or Position: CONTROLLER
Credential:
Phone: 323-465-2106