Healthcare Provider Details

I. General information

NPI: 1982773990
Provider Name (Legal Business Name): LA HUNTINGTON HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 HUNTINGTON DRIVE S.
LOS ANGELES CA
90032-1940
US

IV. Provider business mailing address

1101 CRENSHAW BLVD
LOS ANGELES CA
90019-3112
US

V. Phone/Fax

Practice location:
  • Phone: 323-225-5991
  • Fax:
Mailing address:
  • Phone: 323-935-8490
  • Fax: 323-935-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000057
License Number StateCA

VIII. Authorized Official

Name: MRS. JOAN LEE
Title or Position: PRESIDENT/ CEO
Credential: R.N.
Phone: 323-935-8490