Healthcare Provider Details

I. General information

NPI: 1063409472
Provider Name (Legal Business Name): BAY CREST CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 GARNET STREET
TORRANCE CA
90503-3305
US

IV. Provider business mailing address

3750 GARNET STREET
TORRANCE CA
90503-3305
US

V. Phone/Fax

Practice location:
  • Phone: 310-371-2431
  • Fax: 310-214-4944
Mailing address:
  • Phone: 310-371-2431
  • Fax: 310-214-4944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number910000008
License Number StateCA

VIII. Authorized Official

Name: MICHAEL T. BERG
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 505-468-4752