MEDICARE: BIXBY KNOLLS TOWERS, 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	940000023	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	:	1932104213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIXBY KNOLLS TOWERS, INC

Provider Business Mailing Address
First Line	:	3747 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3428
Country	:	US
Telephone Number	:	562-426-6123
Fax Number	:	562-426-1506

Provider Business Practice Location Address
First Line	:	3747 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3428
Country	:	US
Telephone Number	:	562-426-6123
Fax Number	:	562-426-1506

Authorized Official
Title or Position	:	V.P. OF OPERATIONS
Name	:	STUART HARTMAN
Credential	:
Telephone Number	:	562-257-5100

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	11/26/2008

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