Healthcare Provider Details

I. General information

NPI: 1124134572
Provider Name (Legal Business Name): SILVERSCREEN HEALTHCARE
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

10830 OXNARD ST
N HOLLYWOOD CA
91606-5021
US

IV. Provider business mailing address

10830 OXNARD ST
N HOLLYWOOD CA
91606-5021
US

V. Phone/Fax

Practice location:
  • Phone: 818-763-8247
  • Fax: 818-762-8279
Mailing address:
  • Phone: 818-763-8247
  • Fax: 818-762-8279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number920000036
License Number StateCA

VIII. Authorized Official

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