MEDICARE: WASHINGTON ENTERPRISES III, 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

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	:	1346221819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON ENTERPRISES III, LLC

Provider Business Mailing Address
First Line	:	2300 W. WASHINGTON BLVD.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-1445
Country	:	US
Telephone Number	:	323-731-0861
Fax Number	:	323-735-0616

Provider Business Practice Location Address
First Line	:	2300 W. WASHINGTON BLVD.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-1445
Country	:	US
Telephone Number	:	323-731-0861
Fax Number	:	323-735-0616

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NATHANIEL RIVERA CHIVI
Credential	:
Telephone Number	:	323-731-0861

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	01/05/2012

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