Healthcare Provider Details

I. General information

NPI: 1154359586
Provider Name (Legal Business Name): KTLA PROPERTIES LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 KATELLA AVE
LOS ALAMITOS CA
90720-3304
US

IV. Provider business mailing address

1107 HAZELTINE BLVD SUITE 200
CHASKA MN
55318-1009
US

V. Phone/Fax

Practice location:
  • Phone: 562-596-5561
  • Fax: 562-596-5516
Mailing address:
  • Phone: 952-361-8000
  • Fax: 952-361-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060000076
License Number StateCA

VIII. Authorized Official

Name: JAMES A WEICHERT
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 952-361-8000