Healthcare Provider Details

I. General information

NPI: 1487970927
Provider Name (Legal Business Name): SKYLINE HEALTHCARE & WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3032 ROWENA AVE
LOS ANGELES CA
90039-2005
US

IV. Provider business mailing address

3032 ROWENA AVE
LOS ANGELES CA
90039-2005
US

V. Phone/Fax

Practice location:
  • Phone: 323-665-1185
  • Fax: 323-913-0796
Mailing address:
  • Phone: 323-665-1185
  • Fax: 323-913-0796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000048
License Number StateCA

VIII. Authorized Official

Name: MOISHE FRANKEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 323-828-3832