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NPI Code Detail

MEDICARE: MEK LONG BEACH, LLC

MEDICARE: MEK LONG BEACH, 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
1314000000XSkilled Nursing Facility940000065CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
205D0891347OTHERCACLIA ID NUMBER

General Provider Information

NPI Number : 1508862798
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEK LONG BEACH, LLC
Provider Business Mailing Address
First Line : 1506 S GLENDALE AVE
Second Line :
City : GLENDALE
State : CA
Zip : 91205-3316
Country : US
Telephone Number : 818-247-6200
Fax Number : 818-247-7129
Provider Business Practice Location Address
First Line : 3850 E ESTHER ST
Second Line :
City : LONG BEACH
State : CA
Zip : 90804-2009
Country : US
Telephone Number : 562-498-3368
Fax Number : 562-494-1786
Authorized Official
Title or Position : FINANCIAL CONTROLLER
Name : MR. FERNAN PERDRAJA
Credential :
Telephone Number : 818-247-6200
Provider Enumeration Date : 06/22/2005
Last Update Date : 04/11/2016

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Directions to “MEK LONG BEACH, LLC ” Practice Location

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