Healthcare Provider Details

I. General information

NPI: 1942906391
Provider Name (Legal Business Name): TOPANGA BEACH HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 S LAKE ST
LOS ANGELES CA
90057-4013
US

IV. Provider business mailing address

701 PALOMAR AIRPORT RD STE 230
CARLSBAD CA
92011-1046
US

V. Phone/Fax

Practice location:
  • Phone: 213-380-9175
  • Fax:
Mailing address:
  • Phone: 760-656-6985
  • Fax: 760-867-2664

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: METTE OCONNOR
Title or Position: CONTROLLER
Credential:
Phone: 760-656-6985