Healthcare Provider Details

I. General information

NPI: 1871529867
Provider Name (Legal Business Name): SYCAMORE PARK CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4585 N FIGUEROA ST
LOS ANGELES CA
90065-3026
US

IV. Provider business mailing address

4585 N FIGUEROA ST
LOS ANGELES CA
90065-3026
US

V. Phone/Fax

Practice location:
  • Phone: 132-322-3244
  • Fax: 132-322-3956
Mailing address:
  • Phone: 132-322-3244
  • Fax: 132-322-3956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000054
License Number StateCA

VIII. Authorized Official

Name: MR. PETE STONG
Title or Position: GOVERNING BODY
Credential:
Phone: 13232233441