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General NPI Number Information
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NPI Number | 1790001212
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Entity Type | Organization
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Legal Business Name | DRIFTWOOD HEALTHCARE & WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 04/08/2010
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 4109 EMERALD ST
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City | TORRANCE
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State | CA
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Zip | 90503-3105
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Country | US
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Telephone | 310-371-4628
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Fax | 310-214-1882
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Provider Business Mailing Address
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Address Line | 4109 EMERALD ST
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City | TORRANCE
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State | CA
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Zip | 90503-3105
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Country | US
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Telephone | 310-371-4628
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Fax | 310-214-1882
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN WEISS
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Credential |
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Telephone | 32238555492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 910000045
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License Number State | CA
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