MEDICARE: CULVER WEST HEALTH 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
1	314000000X	Skilled Nursing Facility	910000038	CA

General Provider Information

NPI Number	:	1710379946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CULVER WEST HEALTH CENTER, LLC

Provider Business Mailing Address
First Line	:	4035 GRAND VIEW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5211
Country	:	US
Telephone Number	:	714-310-3909
Fax Number	:	310-398-7470

Provider Business Practice Location Address
First Line	:	4035 GRAND VIEW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5211
Country	:	US
Telephone Number	:	714-310-3909
Fax Number	:	310-398-7470

Authorized Official
Title or Position	:	MANAGER
Name	:	HARRY JACOBS
Credential	:
Telephone Number	:	310-390-9506

Provider Enumeration Date	:	02/25/2015
Last Update Date	:	10/21/2015

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