Healthcare Provider Details

I. General information

NPI: 1710227996
Provider Name (Legal Business Name): PLAZA HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 HEMLOCK WAY
SANTA ANA CA
92707-3609
US

IV. Provider business mailing address

1209 HEMLOCK WAY
SANTA ANA CA
92707-3609
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-1966
  • Fax: 714-546-6719
Mailing address:
  • Phone: 714-546-1966
  • Fax: 714-546-6719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060000168
License Number StateCA

VIII. Authorized Official

Name: MR. STEPHEN REISSMAN
Title or Position: CEO
Credential:
Phone: 310-574-3733