Healthcare Provider Details

I. General information

NPI: 1922411735
Provider Name (Legal Business Name): AVALON POST ACUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12029 AVALON BLVD
LOS ANGELES CA
90061-2838
US

IV. Provider business mailing address

4032 WILSHIRE BLVD SUITE 600
LOS ANGELES CA
90010-3405
US

V. Phone/Fax

Practice location:
  • Phone: 323-756-8191
  • Fax:
Mailing address:
  • Phone: 213-389-6900
  • 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: MS. KERRI SANDOVAL
Title or Position: ADMIN ASST
Credential:
Phone: 213-389-6900