Healthcare Provider Details

I. General information

NPI: 1548684467
Provider Name (Legal Business Name): 2210 SANTA ANA OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 E 1ST ST
SANTA ANA CA
92705-3802
US

IV. Provider business mailing address

11440 VENTURA BLVD STE 220
STUDIO CITY CA
91604-3154
US

V. Phone/Fax

Practice location:
  • Phone: 818-985-6600
  • Fax:
Mailing address:
  • Phone: 818-985-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MANACHEM MENDEL GASTWIRTH
Title or Position: OWNER
Credential:
Phone: 818-915-4900