MEDICARE: COUNTRY VILLA EAST L.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	970000018	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043204324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTRY VILLA EAST L.P.

Provider Business Mailing Address
First Line	:	3580 WILSHIRE BLVD STE 600
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-2608
Country	:	US
Telephone Number	:	323-734-1101
Fax Number	:	323-734-3872

Authorized Official
Title or Position	:	MANAGING MEMBER OF GENERAL PARTNER
Name	:	MR. STEPHEN E. REISSMAN
Credential	:
Telephone Number	:	310-574-3733

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	09/14/2022

Similar Medicare Providers

1083959423 — EAST HEALTHCARE CENTER, LLC
Practice Location Address:

2415 S WESTERN AVE
LOS ANGELES, CA
90018-2608

Practice Phone: 323-734-1101
Practice Fax: 323-734-3872

1780093393 — EAST TERRACE REHABILITATION & WELLNESS CENTRE LP
Practice Location Address:

2415 S WESTERN AVE
LOS ANGELES, CA
90018-2608

Practice Phone: 323-734-1101
Practice Fax: 323-734-3872

1811469612 — JUDE ANDREW CARBON
Practice Location Address:

2415 S WESTERN AVE
LOS ANGELES, CA
90018-2608

Practice Phone: 323-734-1101
Practice Fax:

1811956774 — DR. ALICIA H CHANG M.D.
Practice Location Address:

2615 S GRAND AVE
LOS ANGELES, CA
90007-2608

Practice Phone: 213-745-0846
Practice Fax:

1891880142 — CHRISTINE L WIGEN M.D.
Practice Location Address:

2615 S GRAND AVE , ROOM 500
LOS ANGELES, CA
90007-2608

Practice Phone: 213-744-3070
Practice Fax: 213-749-9606

1780728279 — DR. DEL FORREST BARRETT O.D.
Practice Location Address:

2650 E OLYMPIC BLVD
LOS ANGELES, CA
90023-2608

Practice Phone: 323-260-7410
Practice Fax: 323-261-2486

Directions to “COUNTRY VILLA EAST L.P. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.