Healthcare Provider Details

I. General information

NPI: 1710379946
Provider Name (Legal Business Name): CULVER WEST HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4035 GRAND VIEW BLVD
LOS ANGELES CA
90066-5211
US

IV. Provider business mailing address

4035 GRAND VIEW BLVD
LOS ANGELES CA
90066-5211
US

V. Phone/Fax

Practice location:
  • Phone: 714-310-3909
  • Fax: 310-398-7470
Mailing address:
  • Phone: 714-310-3909
  • Fax: 310-398-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number910000038
License Number StateCA

VIII. Authorized Official

Name: HARRY JACOBS
Title or Position: MANAGER
Credential:
Phone: 310-390-9506