Healthcare Provider Details

I. General information

NPI: 1326111402
Provider Name (Legal Business Name): WESTLAKE HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 FAIRVIEW RD
THOUSAND OAKS CA
91361-2456
US

IV. Provider business mailing address

1101 CRENSHAW BLVD
LOS ANGELES CA
90019-3112
US

V. Phone/Fax

Practice location:
  • Phone: 805-494-1233
  • Fax: 805-494-1411
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 Number050000569
License Number StateCA

VIII. Authorized Official

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