Healthcare Provider Details

I. General information

NPI: 1417273798
Provider Name (Legal Business Name): KIRKSIDE FACILITIES OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6380 WILSHIRE BLVD
LOS ANGELES CA
90048-5003
US

IV. Provider business mailing address

6380 WILSHIRE BLVD
LOS ANGELES CA
90048-5003
US

V. Phone/Fax

Practice location:
  • Phone: 323-651-1808
  • Fax:
Mailing address:
  • Phone: 323-651-1808
  • 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: DOUGLAS EASTON
Title or Position: OWNER
Credential:
Phone: 702-308-7191