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General NPI Number Information
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NPI Number | 1962970533
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Entity Type | Organization
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Legal Business Name | HIGHLAND WELLNESSCARE, LLC
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Dates
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Enumeration Date | 11/12/2018
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Last Update Date | 11/12/2018
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Provider Practice Location Address
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Address Line | 2102 S 96TH ST
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City | TACOMA
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State | WA
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Zip | 98444-1753
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Country | US
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Telephone | 323-581-2514
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Fax |
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Provider Business Mailing Address
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Address Line | 106 S HIGHLAND AVE
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City | LOS ANGELES
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State | CA
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Zip | 90036-3029
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Country | US
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Telephone | 323-493-2642
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JONAH WEISS
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Credential |
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Telephone | 323-493-2642
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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 |
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License Number State |
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