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NPI Code Detail

MEDICARE: COUNTRY VILLA EAST, L.P.

MEDICARE: COUNTRY VILLA EAST, L.P.
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 Facility920000065CA

Other Identifiers

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

General Provider Information

NPI Number : 1538153572
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTRY VILLA EAST, L.P.
Provider Business Mailing Address
First Line : 400 EXCHANGE STE 140
Second Line :
City : IRVINE
State : CA
Zip : 92602-1343
Country : US
Telephone Number : 714-673-6870
Fax Number : 949-954-6373
Provider Business Practice Location Address
First Line : 9655 SEPULVEDA BLVD
Second Line :
City : NORTH HILLS
State : CA
Zip : 91343-3307
Country : US
Telephone Number : 818-892-8665
Fax Number : 818-891-1208
Authorized Official
Title or Position : MANAGING MEMBER OF GENERAL PARTNER
Name : MR. STEPHEN E. REISSMAN
Credential :
Telephone Number : 310-574-3733
Provider Enumeration Date : 09/06/2005
Last Update Date : 09/07/2022

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Directions to “COUNTRY VILLA EAST, L.P. ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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