Healthcare Provider Details

I. General information

NPI: 1912454851
Provider Name (Legal Business Name): SIMI VALLEY HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 S MYRTLE AVE SUITE B
MONROVIA CA
91016-6154
US

IV. Provider business mailing address

5270 E LOS ANGELES AVE
SIMI VALLEY CA
93063-4137
US

V. Phone/Fax

Practice location:
  • Phone: 626-658-7344
  • Fax: 323-488-9274
Mailing address:
  • Phone: 805-522-9155
  • Fax: 805-581-3879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number050000069
License Number StateCA

VIII. Authorized Official

Name: CRYSTAL SOLORZANO
Title or Position: CEO
Credential:
Phone: 323-836-9397