Healthcare Provider Details

I. General information

NPI: 1790772465
Provider Name (Legal Business Name): GREENFIELD CARE CENTER OF SOUTH GATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2005
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8455 STATE ST
SOUTH GATE CA
90280-2330
US

IV. Provider business mailing address

1937 PONTIUS AVE
LOS ANGELES CA
90025-5611
US

V. Phone/Fax

Practice location:
  • Phone: 323-564-7761
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000160
License Number StateCA

VIII. Authorized Official

Name: MR. JENG H CHEN
Title or Position: OWNER
Credential:
Phone: 310-889-9929