MEDICARE: ROSCOE CARE CENTER LLC

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

General Provider Information

NPI Number	:	1174211072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSCOE CARE CENTER LLC

Provider Business Mailing Address
First Line	:	6442 COLDWATER CANYON AVE STE 100
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1191
Country	:	US
Telephone Number	:	818-853-5760
Fax Number	:

Provider Business Practice Location Address
First Line	:	14857 ROSCOE BLVD
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4617
Country	:	US
Telephone Number	:	818-894-5707
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	CHONOCH GEWIRTZ
Credential	:
Telephone Number	:	818-853-5760

Provider Enumeration Date	:	04/27/2023
Last Update Date	:	05/01/2023

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Directions to “ROSCOE CARE CENTER LLC ” Practice Location

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