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NPI Code Detail

MEDICARE: BLYTHE/WINDSOR COUNTRY PARK HEALTHCARE CENTER, LLC

MEDICARE: BLYTHE/WINDSOR COUNTRY PARK HEALTHCARE 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
1314000000XSkilled Nursing Facility940000067CA

General Provider Information

NPI Number : 1619121092
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLYTHE/WINDSOR COUNTRY PARK HEALTHCARE CENTER, LLC
Provider Business Mailing Address
First Line : 3232 E ARTESIA BLVD
Second Line :
City : LONG BEACH
State : CA
Zip : 90805-2811
Country : US
Telephone Number : 562-422-9219
Fax Number : 562-428-0280
Provider Business Practice Location Address
First Line : 3232 E ARTESIA BLVD
Second Line :
City : LONG BEACH
State : CA
Zip : 90805-2811
Country : US
Telephone Number : 562-422-9219
Fax Number : 562-428-0280
Authorized Official
Title or Position : VICE PRESIDENT, FINANCE
Name : MR. ASH CHAWLA
Credential :
Telephone Number : 310-385-1090
Provider Enumeration Date : 11/11/2008
Last Update Date : 01/02/2014

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