=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982773990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA HUNTINGTON HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 10/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4515 HUNTINGTON DRIVE S.
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90032-1940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-225-5991
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1101 CRENSHAW BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90019-3112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-935-8490
-----------------------------------------------------
Fax | 323-935-8494
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/ CEO
-----------------------------------------------------
Name | MRS. JOAN LEE
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 323-935-8490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 970000057
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------