MEDICARE: VA GREATER LA HEALTHCARE SYSTEM

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	275N00000X	Medicare Defined Swing Bed Hospital Unit	14381	CA

General Provider Information

NPI Number	:	1154431096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VA GREATER LA HEALTHCARE SYSTEM

Provider Business Mailing Address
First Line	:	1825 N KINGSLEY DR APT 506
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-3755
Country	:	US
Telephone Number	:	310-478-3711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 N KINGSLEY DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-3762
Country	:	US
Telephone Number	:	323-962-2946
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MS. JANA S GOTTFRIED
Credential	:	MSW
Telephone Number	:	310-478-3711

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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