Healthcare Provider Details

I. General information

NPI: 1346221819
Provider Name (Legal Business Name): WASHINGTON ENTERPRISES III, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W. WASHINGTON BLVD.
LOS ANGELES CA
90018-1445
US

IV. Provider business mailing address

2300 W. WASHINGTON BLVD.
LOS ANGELES CA
90018-1445
US

V. Phone/Fax

Practice location:
  • Phone: 323-731-0861
  • Fax: 323-735-0616
Mailing address:
  • Phone: 323-731-0861
  • Fax: 323-735-0616

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: NATHANIEL RIVERA CHIVI
Title or Position: ADMINISTRATOR
Credential:
Phone: 323-731-0861