Healthcare Provider Details

I. General information

NPI: 1801836622
Provider Name (Legal Business Name): GOLDSTAR HEALTHCARE CENTER OF SANTA MONICA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 15TH ST
SANTA MONICA CA
90404-1802
US

IV. Provider business mailing address

1340 15TH ST
SANTA MONICA CA
90404-1802
US

V. Phone/Fax

Practice location:
  • Phone: 310-451-9706
  • Fax: 310-451-0369
Mailing address:
  • Phone: 310-451-9706
  • Fax: 310-451-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number910000016
License Number StateCA

VIII. Authorized Official

Name: MR. DOV GOLDNER
Title or Position: PRESIDENT
Credential: OWNER
Phone: 323-610-3655