Healthcare Provider Details

I. General information

NPI: 1083703573
Provider Name (Legal Business Name): NORWALK MEADOWS NURSING CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10625 LEFFINGWELL RD
NORWALK CA
90650
US

IV. Provider business mailing address

1141 S BEVERLY DR
LOS ANGELES CA
90035-1119
US

V. Phone/Fax

Practice location:
  • Phone: 562-864-2541
  • Fax: 562-864-2231
Mailing address:
  • Phone: 310-286-3074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000079
License Number StateCA

VIII. Authorized Official

Name: MR. JACOB M GRAFF
Title or Position: MANAGING MEMBER
Credential:
Phone: 310-286-3074