Healthcare Provider Details

I. General information

NPI: 1760470736
Provider Name (Legal Business Name): ALEXANDRIA CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N ALEXANDRIA AVE
LOS ANGELES CA
90027-5203
US

IV. Provider business mailing address

1515 N ALEXANDRIA AVE
LOS ANGELES CA
90027-5203
US

V. Phone/Fax

Practice location:
  • Phone: 323-660-1800
  • Fax: 323-660-0023
Mailing address:
  • Phone: 323-660-1800
  • Fax: 323-660-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000002
License Number StateCA

VIII. Authorized Official

Name: MICHAEL T. BERG
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 505-468-4752