MEDICARE: SH ESCALATE ENTERPRISE, 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	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1528568169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SH ESCALATE ENTERPRISE, INC.

Provider Business Mailing Address
First Line	:	2722 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-3030
Country	:	US
Telephone Number	:	323-643-4880
Fax Number	:	323-643-4838

Provider Business Practice Location Address
First Line	:	2722 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-3030
Country	:	US
Telephone Number	:	323-643-4880
Fax Number	:	323-643-4838

Authorized Official
Title or Position	:	CEO/ADM/DPCS
Name	:	MRS. MIYOUNG LIM
Credential	:	RN
Telephone Number	:	213-446-3046

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	02/20/2018

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Directions to “SH ESCALATE ENTERPRISE, INC. ” Practice Location

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