Healthcare Provider Details

I. General information

NPI: 1760477558
Provider Name (Legal Business Name): SOUTHLAND MANAGMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11701 STUDEBAKER RD
NORWALK CA
90650-7544
US

IV. Provider business mailing address

11701 STUDEBAKER RD
NORWALK CA
90650-7544
US

V. Phone/Fax

Practice location:
  • Phone: 562-868-9761
  • Fax: 562-863-0336
Mailing address:
  • Phone: 562-868-9761
  • Fax: 562-863-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000156
License Number StateCA

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 949-540-1249