MEDICARE: 533 SOUTH FAIRFAX AVENUE 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	314000000X	Skilled Nursing Facility	910000146	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1639166242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	533 SOUTH FAIRFAX AVENUE INC

Provider Business Mailing Address
First Line	:	4115 E BROADWAY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-1532
Country	:	US
Telephone Number	:	562-930-0777
Fax Number	:	562-930-0728

Provider Business Practice Location Address
First Line	:	533 S FAIRFAX AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3129
Country	:	US
Telephone Number	:	323-931-1061
Fax Number	:	323-931-1943

Authorized Official
Title or Position	:	MANAGER
Name	:	ROSALIE PIACENTI SANCHEZ
Credential	:
Telephone Number	:	562-930-0777

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	12/08/2010

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