Healthcare Provider Details

I. General information

NPI: 1083959423
Provider Name (Legal Business Name): EAST HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 S WESTERN AVE
LOS ANGELES CA
90018-2608
US

IV. Provider business mailing address

2415 S WESTERN AVE
LOS ANGELES CA
90018-2608
US

V. Phone/Fax

Practice location:
  • Phone: 323-734-1101
  • Fax: 323-734-3872
Mailing address:
  • Phone: 323-734-1101
  • Fax: 323-734-3872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000018
License Number StateCA

VIII. Authorized Official

Name: MRS. CHERYL A PETTERSON
Title or Position: VP BUSINESS SERVICES
Credential:
Phone: 323-596-2145