Healthcare Provider Details

I. General information

NPI: 1982960209
Provider Name (Legal Business Name): SHERATON HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9655 SEPULVEDA BLVD
NORTH HILLS CA
91343-3307
US

IV. Provider business mailing address

5120 W GOLDLEAF CIR STE 400
LOS ANGELES CA
90056-1297
US

V. Phone/Fax

Practice location:
  • Phone: 323-596-2145
  • Fax: 323-596-4645
Mailing address:
  • Phone: 310-574-3733
  • Fax: 323-596-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number920000065
License Number StateCA

VIII. Authorized Official

Name: MR. STEPHEN REISSMAN
Title or Position: CEO/CHAIRMAN
Credential:
Phone: 310-574-3733