Healthcare Provider Details

I. General information

NPI: 1679798086
Provider Name (Legal Business Name): SUNNYSIDE NURSING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22617 S. VERMONT AVE
TORRANCE CA
90502
US

IV. Provider business mailing address

18757 BURBANK BLVD SUITE 130
TARZANA CA
91356
US

V. Phone/Fax

Practice location:
  • Phone: 310-320-4130
  • Fax:
Mailing address:
  • Phone: 818-345-8355
  • Fax: 818-345-8755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL SCHWARTZ
Title or Position: AGENT
Credential:
Phone: 818-345-8355