Healthcare Provider Details

I. General information

NPI: 1114090206
Provider Name (Legal Business Name): GOOD SHEPHERD HEALTH CARE CENTER OF SANTA MONICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 ARIZONA AVE
SANTA MONICA CA
90401-2009
US

IV. Provider business mailing address

1101 CRENSHAW BLVD
LOS ANGELES CA
90019-3112
US

V. Phone/Fax

Practice location:
  • Phone: 310-451-4800
  • Fax: 310-458-3156
Mailing address:
  • Phone: 323-934-5660
  • Fax: 323-934-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number910000056
License Number StateCA

VIII. Authorized Official

Name: MS. JOAN LEE
Title or Position: PRESIDENT
Credential:
Phone: 323-934-5660