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General NPI Number Information
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NPI Number | 1871529867
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Entity Type | Organization
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Legal Business Name | SYCAMORE PARK CARE CENTER, LLC
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 09/08/2011
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Provider Practice Location Address
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Address Line | 4585 N FIGUEROA ST
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City | LOS ANGELES
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State | CA
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Zip | 90065-3026
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Country | US
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Telephone | 132-322-3244
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Fax | 132-322-3956
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Provider Business Mailing Address
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Address Line | 4585 N FIGUEROA ST
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City | LOS ANGELES
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State | CA
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Zip | 90065-3026
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Country | US
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Telephone | 132-322-3244
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Fax | 132-322-3956
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Authorized Official
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Title or Position | GOVERNING BODY
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Name | MR. PETE STONG
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Credential |
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Telephone | 13232233441
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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 | 970000054
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License Number State | CA
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