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NPI Code Detail

MEDICARE: CHEVIOT GARDEN LP

MEDICARE: CHEVIOT GARDEN LP
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 Facility910000090CA

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 : 1720073059
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHEVIOT GARDEN LP
Provider Business Mailing Address
First Line : 5120 W GOLDLEAF CIR
Second Line : SUITE 400
City : LOS ANGELES
State : CA
Zip : 90056-1292
Country : US
Telephone Number : 310-574-3733
Fax Number : 310-574-1322
Provider Business Practice Location Address
First Line : 3533 MOTOR AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-4806
Country : US
Telephone Number : 310-836-8900
Fax Number : 310-815-9786
Authorized Official
Title or Position : PRESIDENT OF CVHS, MANAGER
Name : MR. STEPHEN E. REISSMAN
Credential :
Telephone Number : 310-574-3733
Provider Enumeration Date : 09/13/2005
Last Update Date : 04/30/2008

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