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NPI Code Detail

MEDICARE: 2210 SANTA ANA OPCO, LLC

MEDICARE: 2210 SANTA ANA OPCO, 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 Facility

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 : 1548684467
Entity Type Code : Organization
Provider Name (Legal Business Name) : 2210 SANTA ANA OPCO, LLC
Provider Business Mailing Address
First Line : 11440 VENTURA BLVD
Second Line : STE 220
City : STUDIO CITY
State : CA
Zip : 91604-3154
Country : US
Telephone Number : 818-985-6600
Fax Number :
Provider Business Practice Location Address
First Line : 2210 E 1ST ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-3802
Country : US
Telephone Number : 818-985-6600
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MANACHEM MENDEL GASTWIRTH
Credential :
Telephone Number : 818-915-4900
Provider Enumeration Date : 02/12/2014
Last Update Date : 07/11/2023

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