MEDICARE: LONG BEACH POST ACUTE 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	94000173	CA

General Provider Information

NPI Number	:	1811390693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG BEACH POST ACUTE LLC

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	:	562-930-0777

Provider Business Practice Location Address
First Line	:	1201 WALNUT AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3822
Country	:	US
Telephone Number	:	562-591-7621
Fax Number	:	562-591-3292

Authorized Official
Title or Position	:	MANAGER
Name	:	SIMCHA MANDELBAUM
Credential	:
Telephone Number	:	562-930-0777

Provider Enumeration Date	:	10/07/2014
Last Update Date	:	10/07/2014

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Directions to “LONG BEACH POST ACUTE LLC ” Practice Location

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