=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548684467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 2210 SANTA ANA OPCO, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2014
-----------------------------------------------------
Last Update Date | 07/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2210 E 1ST ST
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92705-3802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-985-6600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11440 VENTURA BLVD STE 220
-----------------------------------------------------
City | STUDIO CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91604-3154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-985-6600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MANACHEM MENDEL GASTWIRTH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-915-4900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------