Healthcare Provider Details

I. General information

NPI: 1720153620
Provider Name (Legal Business Name): THE EARLWOOD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20820 EARL ST
TORRANCE CA
90503-4307
US

IV. Provider business mailing address

20820 EARL ST
TORRANCE CA
90503-4307
US

V. Phone/Fax

Practice location:
  • Phone: 310-371-1228
  • Fax: 310-793-0448
Mailing address:
  • Phone: 310-371-1228
  • Fax: 310-793-0448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number910000041
License Number StateCA

VIII. Authorized Official

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