Healthcare Provider Details

I. General information

NPI: 1609047117
Provider Name (Legal Business Name): HIGHLAND PARK SKILLED NURSING & WELLNESS CENTRE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5125 MONTE VISTA ST
LOS ANGELES CA
90042-3931
US

IV. Provider business mailing address

5125 MONTE VISTA ST
LOS ANGELES CA
90042-3931
US

V. Phone/Fax

Practice location:
  • Phone: 323-254-6125
  • Fax: 323-254-0293
Mailing address:
  • Phone: 323-254-6125
  • Fax: 323-254-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000058
License Number StateCA

VIII. Authorized Official

Name: SHLOMO RECHNITZ
Title or Position: MANAGING MEMBER
Credential:
Phone: 626-800-1191