Healthcare Provider Details

I. General information

NPI: 1487681631
Provider Name (Legal Business Name): GRANCELL VILLAGE OF THE LOS ANGELES JEWISH HOME FOR THE AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 TAMPA AVE
RESEDA CA
91335-3700
US

IV. Provider business mailing address

7150 TAMPA AVE
RESEDA CA
91335-3700
US

V. Phone/Fax

Practice location:
  • Phone: 818-774-3000
  • Fax:
Mailing address:
  • Phone: 818-774-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number550000621
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberHSP48566
License Number StateCA

VIII. Authorized Official

Name: SHERRI CUNNINGHAM
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 818-774-3000