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General NPI Number Information
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NPI Number | 1790772465
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Entity Type | Organization
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Legal Business Name | GREENFIELD CARE CENTER OF SOUTH GATE LLC
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Dates
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Enumeration Date | 09/28/2005
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Last Update Date | 03/25/2020
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Provider Practice Location Address
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Address Line | 8455 STATE ST
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City | SOUTH GATE
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State | CA
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Zip | 90280-2330
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Country | US
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Telephone | 323-564-7761
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Fax |
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Provider Business Mailing Address
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Address Line | 1937 PONTIUS AVE
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City | LOS ANGELES
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State | CA
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Zip | 90025-5611
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JENG H CHEN
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Credential |
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Telephone | 310-889-9929
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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 | 940000160
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License Number State | CA
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