Healthcare Provider Details

I. General information

NPI: 1649386004
Provider Name (Legal Business Name): P & M HEALTHCARE HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S UNION AVE
LOS ANGELES CA
90017-1007
US

IV. Provider business mailing address

415 S UNION AVE
LOS ANGELES CA
90017-1007
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-0784
  • Fax: 213-484-1003
Mailing address:
  • Phone: 213-484-0784
  • Fax: 213-484-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARYLYNN MAHAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 909-987-7735