Healthcare Provider Details

I. General information

NPI: 1336164151
Provider Name (Legal Business Name): CHA HOLLYWOOD MEDICAL CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4636 FOUNTAIN AVE
LOS ANGELES CA
90029-1830
US

IV. Provider business mailing address

1300 N VERMONT AVE
LOS ANGELES CA
90027-6005
US

V. Phone/Fax

Practice location:
  • Phone: 323-913-4830
  • Fax: 323-913-4552
Mailing address:
  • Phone: 213-413-3000
  • Fax: 323-660-0446

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. KENNETH I RIVERS
Title or Position: PRESIDENT, CEO
Credential:
Phone: 323-913-4914