MEDICARE: HOLLYWOOD ELDERLY CARE, INC.

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	310400000X	Assisted Living Facility	197608020	CA

General Provider Information

NPI Number	:	1427346527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLYWOOD ELDERLY CARE, INC.

Provider Business Mailing Address
First Line	:	6054 FRANKLIN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5521
Country	:	US
Telephone Number	:	323-466-2411
Fax Number	:	323-466-9468

Provider Business Practice Location Address
First Line	:	6054 FRANKLIN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5521
Country	:	US
Telephone Number	:	323-466-2411
Fax Number	:	323-466-9468

Authorized Official
Title or Position	:	CEO
Name	:	MS. NONNA SHAPIRO
Credential	:
Telephone Number	:	323-466-2411

Provider Enumeration Date	:	07/11/2011
Last Update Date	:	12/07/2011

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