Healthcare Provider Details

I. General information

NPI: 1346569258
Provider Name (Legal Business Name): BMS HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8925 MINES AVE
PICO RIVERA CA
90660-3006
US

IV. Provider business mailing address

8925 MINES AVE
PICO RIVERA CA
90660-3006
US

V. Phone/Fax

Practice location:
  • Phone: 562-942-7019
  • Fax:
Mailing address:
  • Phone: 562-942-7019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000008
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierZZT060591
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer

VIII. Authorized Official

Name: MORDECHAI STOCK
Title or Position: CEO
Credential:
Phone: 323-634-1940