MEDICARE: CATERED MANOR 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	:	1477389302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATERED MANOR 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	:	4010 N VIRGINIA RD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2627
Country	:	US
Telephone Number	:	562-426-0394
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ABE BAK
Credential	:
Telephone Number	:	818-853-5760

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	09/09/2024

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